Basic Information
| Provider Information | |||||||||
| NPI: | 1134636301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDENBERG | ||||||||
| FirstName: | RANDI | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 ROBERT PITT DR | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
| FaxNumber: | 8455032298 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 ROBERT PITT DR | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
| FaxNumber: | 8455032298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 061742 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1041C0700X | 01 | NY | TAXONOMY | OTHER | 061742 | 01 | NY | STATE LICENSE | OTHER |