Provider Demographics
NPI:1699888925
Name:DUB, FRIEDA S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FRIEDA
Middle Name:S
Last Name:DUB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 FIFTH AVE
Mailing Address - Street 2:IN CARE OF MEDICAL DIRECTOR INC
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1265
Mailing Address - Country:US
Mailing Address - Phone:914-629-6290
Mailing Address - Fax:914-633-7222
Practice Address - Street 1:629 FIFTH AVE
Practice Address - Street 2:IN CARE OF MEDICAL DIRECTOR INC
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1265
Practice Address - Country:US
Practice Address - Phone:914-629-6290
Practice Address - Fax:914-633-7222
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0261071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N3C411Medicare ID - Type Unspecified