Provider Demographics
NPI:1851442735
Name:FRIEND, MICHAEL (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FRIEND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 EARL AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3204
Mailing Address - Country:US
Mailing Address - Phone:401-486-5234
Mailing Address - Fax:
Practice Address - Street 1:25 MARKET ST STE 14
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3998
Practice Address - Country:US
Practice Address - Phone:401-486-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013001041C0700X
MA1170901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical