Provider Demographics
NPI:1568868636
Name:FRIEDHEIM, ROSE EVELYN
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:EVELYN
Last Name:FRIEDHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1725
Mailing Address - Country:US
Mailing Address - Phone:510-841-9230
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 2700
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6475
Practice Address - Country:US
Practice Address - Phone:808-376-9479
Practice Address - Fax:888-375-4522
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIPSY-2192-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program