Provider Demographics
NPI:1306893938
Name:MARVIN FREDMAN, INC.
Entity type:Organization
Organization Name:MARVIN FREDMAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-417-0571
Mailing Address - Street 1:7000 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3424
Mailing Address - Country:US
Mailing Address - Phone:561-417-0571
Mailing Address - Fax:561-417-0579
Practice Address - Street 1:7000 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3424
Practice Address - Country:US
Practice Address - Phone:561-417-0571
Practice Address - Fax:561-417-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75206Medicare ID - Type Unspecified