Provider Demographics
NPI:1053550103
Name:WILLIAM P FRIEDENBERG PHD
Entity type:Organization
Organization Name:WILLIAM P FRIEDENBERG PHD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FRIEDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-253-2531
Mailing Address - Street 1:403 N WILD OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3937
Mailing Address - Country:US
Mailing Address - Phone:386-253-2531
Mailing Address - Fax:386-253-6144
Practice Address - Street 1:403 N WILD OLIVE AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3937
Practice Address - Country:US
Practice Address - Phone:386-253-2531
Practice Address - Fax:386-253-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2214103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75106Medicare UPIN