Provider Demographics
NPI:1306066253
Name:FRIEDMAN, MARTIN R (PHD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:FRIEDMAN
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 1:400 BOWER RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:PA
Mailing Address - Zip Code:16124-1406
Mailing Address - Country:US
Mailing Address - Phone:724-475-4042
Mailing Address - Fax:
Practice Address - Street 1:400 BOWER RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:PA
Practice Address - Zip Code:16124-1406
Practice Address - Country:US
Practice Address - Phone:724-475-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002279-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist