Provider Demographics
NPI:1194484758
Name:FRIEDE, JENNIFER (LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FRIEDE
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:UPR MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1418
Mailing Address - Country:US
Mailing Address - Phone:201-390-9598
Mailing Address - Fax:
Practice Address - Street 1:7 VALLEY PL
Practice Address - Street 2:
Practice Address - City:UPR MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1418
Practice Address - Country:US
Practice Address - Phone:201-390-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002021-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist