Provider Demographics
NPI:1306998612
Name:FRIEDRICKS, LINDA (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FRIEDRICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HALPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:594 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1882
Mailing Address - Country:US
Mailing Address - Phone:973-783-2949
Mailing Address - Fax:973-783-1702
Practice Address - Street 1:594 VALLEY RD
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1882
Practice Address - Country:US
Practice Address - Phone:973-783-2949
Practice Address - Fax:973-783-1702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008552001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFR002543Medicare ID - Type UnspecifiedMEDICARE #