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General NPI Number Information
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NPI Number | 1629213251
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Entity Type | Individual
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Provider Name | ELIZABETH FRIED PH.D., BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 4300 HYLAN BLVD LOWER LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6505
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Country | US
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Telephone | 718-605-0642
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Fax | 718-984-9620
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Provider Business Mailing Address
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Address Line | 41 TYLER AVE APT 2204
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City | ISELIN
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State | NJ
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Zip | 08830-2965
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Country | US
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Telephone | 732-596-1496
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Fax | 877-645-1399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-06-2803
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 012367-1
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License Number State | NY
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