Provider Demographics
NPI:1992873335
Name:FRIDMAN, MYRON STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MYRON
Middle Name:STEPHEN
Last Name:FRIDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 KENWOOD RD
Mailing Address - Street 2:SUITE B110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6895
Mailing Address - Country:US
Mailing Address - Phone:513-794-0808
Mailing Address - Fax:513-489-5158
Practice Address - Street 1:9403 KENWOOD RD
Practice Address - Street 2:SUITE B110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-794-0808
Practice Address - Fax:513-489-5158
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2760103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0579520Medicaid
OH0579520Medicaid