Provider Demographics
NPI:1679605075
Name:FRIEDBERG, FRED (PHD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:FRIEDBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0456
Mailing Address - Country:US
Mailing Address - Phone:516-702-4213
Mailing Address - Fax:
Practice Address - Street 1:187 KENT RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:CT
Practice Address - Zip Code:06754-1606
Practice Address - Country:US
Practice Address - Phone:516-702-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001658103T00000X
NY007502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist