Provider Demographics
NPI:1457467516
Name:FRIEDKIN, MARILYN LOUISE (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LOUISE
Last Name:FRIEDKIN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28286
Mailing Address - Country:US
Mailing Address - Phone:828-456-3246
Mailing Address - Fax:828-452-6259
Practice Address - Street 1:563 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28286
Practice Address - Country:US
Practice Address - Phone:828-456-3246
Practice Address - Fax:828-452-6259
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002871041C0700X
FLSW00017091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
33681OtherBCBS
NC6002006Medicaid
18117297OtherTRICARE MILITARY ONE
33681OtherBCBS