MEDICARE: MS. SUSAN FRIEND MSW

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	LCSW 3422	AZ

General Provider Information

NPI Number	:	1083811327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN FRIEND MSW

Provider Business Mailing Address
First Line	:	3240 E UNION HILLS DR
Second Line	:	STE 149
City	:	PHOENIX
State	:	AZ
Zip	:	85050-2652
Country	:	US
Telephone Number	:	602-274-1616
Fax Number	:	602-274-0141

Provider Business Practice Location Address
First Line	:	3240 E UNION HILLS DR
Second Line	:	STE 149
City	:	PHOENIX
State	:	AZ
Zip	:	85050-2652
Country	:	US
Telephone Number	:	602-274-1616
Fax Number	:	602-274-0141

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	04/12/2017

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