MEDICARE: BENJAMIN FRIDAY

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	106H00000X	Marriage & Family Therapist	122263	CA

General Provider Information

NPI Number	:	1336641125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN FRIDAY

Provider Business Mailing Address
First Line	:	24 BENAVENTE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-8939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 X ST STE A
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-287-3430
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	11/14/2020

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Directions to “ BENJAMIN FRIDAY ” Practice Location

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