MEDICARE: MS. DOROTHY PAULETTE FRIED LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0300491	NY

General Provider Information

NPI Number	:	1073598959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY PAULETTE FRIED LCSW

Provider Business Mailing Address
First Line	:	294 PROSPECT AVE
Second Line	:
City	:	SEA CLIFF
State	:	NY
Zip	:	11579-1026
Country	:	US
Telephone Number	:	516-676-1599
Fax Number	:	516-671-5437

Provider Business Practice Location Address
First Line	:	174 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-2024
Country	:	US
Telephone Number	:	516-775-4258
Fax Number	:	516-671-5437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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