Provider Demographics
NPI:1316544117
Name:FRIEDMAN-LINDQUIST, MIRA (LLMSW)
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:FRIEDMAN-LINDQUIST
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 NICKELS ARC
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2410
Mailing Address - Country:US
Mailing Address - Phone:248-974-2475
Mailing Address - Fax:
Practice Address - Street 1:240 NICKELS ARC
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2410
Practice Address - Country:US
Practice Address - Phone:248-974-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011052671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical