MEDICARE: DENISE FRIEDMAN

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	104100000X	Social Worker	M-08123	NM

General Provider Information

NPI Number	:	1598159360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE FRIEDMAN

Provider Business Mailing Address
First Line	:	8205 SPAIN ROAD NE
Second Line	:	SUITE 106
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3155
Country	:	US
Telephone Number	:	505-384-7352
Fax Number	:	505-274-7338

Provider Business Practice Location Address
First Line	:	2424 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1818
Country	:	US
Telephone Number	:	505-503-1811
Fax Number	:

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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Directions to “ DENISE FRIEDMAN ” Practice Location

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