Provider Demographics
NPI:1538933320
Name:DYER-FRIEDMAN, JENNIFER FRANCES PUALEI (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FRANCES PUALEI
Last Name:DYER-FRIEDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 WAVERLEY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2589
Mailing Address - Country:US
Mailing Address - Phone:650-327-4790
Mailing Address - Fax:
Practice Address - Street 1:690 WAVERLEY ST STE 102
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2589
Practice Address - Country:US
Practice Address - Phone:650-327-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical