Basic Information
| Provider Information | |||||||||
| NPI: | 1346300373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | JEFF | ||||||||
| MiddleName: | BARRY | ||||||||
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| Credential: | LMFT #90726 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 TULE CT | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945171210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259499754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 ROLAND WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108393800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF48054 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT #90726 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.