Provider Demographics
NPI:1891867461
Name:FRIEDMAN, SUSAN LEVINE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEVINE
Last Name:FRIEDMAN
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:PO BOX 11167
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-3367
Mailing Address - Country:US
Mailing Address - Phone:541-484-5594
Mailing Address - Fax:541-344-6254
Practice Address - Street 1:245 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3401
Practice Address - Country:US
Practice Address - Phone:541-484-5594
Practice Address - Fax:541-344-6254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR111923Medicare ID - Type Unspecified