Provider Demographics
NPI:1588712822
Name:FRIEDMAN, LAURIE M (PSYD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 PEARL ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5061
Mailing Address - Country:US
Mailing Address - Phone:303-442-9700
Mailing Address - Fax:
Practice Address - Street 1:767 PEARL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5061
Practice Address - Country:US
Practice Address - Phone:303-442-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1841103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64866Medicare ID - Type Unspecified