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NPI Code Detail

MEDICARE: MS. MARY SARA FRIDMAN MSW, LCSW

MEDICARE: MS. MARY SARA FRIDMAN MSW, 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
11041C0700XClinical Social Worker13082-CNV
2101YA0400XAddiction (Substance Use Disorder) Counselor07974-INV

General Provider Information

NPI Number : 1083191118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY SARA FRIDMAN MSW, LCSW
Provider Business Mailing Address
First Line : 4221 MCLEOD DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5215
Country : US
Telephone Number : 702-474-6450
Fax Number :
Provider Business Practice Location Address
First Line : 4221 MCLEOD DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5215
Country : US
Telephone Number : 702-474-6450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2018
Last Update Date : 05/05/2026

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