Provider Demographics
NPI:1124379821
Name:LISA FRIEDMAN L C S W INC
Entity type:Organization
Organization Name:LISA FRIEDMAN L C S W INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-741-1099
Mailing Address - Street 1:9715 W BROWARD BLVD
Mailing Address - Street 2:P. M. BOX 148
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2351
Mailing Address - Country:US
Mailing Address - Phone:954-741-1099
Mailing Address - Fax:954-585-0177
Practice Address - Street 1:7376 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1605
Practice Address - Country:US
Practice Address - Phone:954-741-1099
Practice Address - Fax:954-585-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9050Medicare PIN