Provider Demographics
NPI:1396951844
Name:FRIEDBERG PSYCHOLOGICAL GROUP INC
Entity type:Organization
Organization Name:FRIEDBERG PSYCHOLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-232-7236
Mailing Address - Street 1:116 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2726
Mailing Address - Country:US
Mailing Address - Phone:337-232-7236
Mailing Address - Fax:337-232-8616
Practice Address - Street 1:116 OAKCREST DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2726
Practice Address - Country:US
Practice Address - Phone:337-232-7236
Practice Address - Fax:337-232-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C707Medicare ID - Type Unspecified