MEDICARE: DR. ELIZABETH MORICK FRIEDMAN PH.D.

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	103G00000X	Clinical Neuropsychologist	071-006059	IL
2	103TC0700X	Clinical Psychologist	071-006059	IL

General Provider Information

NPI Number	:	1104165281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MORICK FRIEDMAN PH.D.

Provider Business Mailing Address
First Line	:	240 CLINTON AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3114
Country	:	US
Telephone Number	:	708-689-0160
Fax Number	:	708-689-8158

Provider Business Practice Location Address
First Line	:	7777 LAKE ST
Second Line	:	SUITE 114
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1734
Country	:	US
Telephone Number	:	708-689-0160
Fax Number	:	708-689-8158

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

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	02/08/2013

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