Provider Demographics
NPI:1285922757
Name:FRIEDMAN, ELLEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:GERACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:5039 GLADSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-2657
Mailing Address - Country:US
Mailing Address - Phone:315-558-9353
Mailing Address - Fax:
Practice Address - Street 1:5039 GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-2657
Practice Address - Country:US
Practice Address - Phone:315-558-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004287101YM0800X, 101YP2500X, 101YA0400X
SC8677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)