=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740280445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL HEALTH MEDICAL GROUP OF BEVERLY HILLS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 08/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9171 WILSHIRE BOULEVARD SUITE 310
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-274-4372
-----------------------------------------------------
Fax | 310-274-5146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9171 WILSHIRE BOULEVARD SUITE 310
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-274-4372
-----------------------------------------------------
Fax | 310-274-5146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR / PSYCHIATRIST
-----------------------------------------------------
Name | BARRY D. FRIEDMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-274-4372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | FNP24674
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------