Provider Demographics
NPI:1386602845
Name:FRIEDMAN, JEROME G (MSW)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:G
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ROUTE 149
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648
Mailing Address - Country:US
Mailing Address - Phone:508-428-3698
Mailing Address - Fax:508-428-0005
Practice Address - Street 1:39 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-2307
Practice Address - Country:US
Practice Address - Phone:508-776-3942
Practice Address - Fax:508-428-0500
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03354Medicare ID - Type Unspecified