Provider Demographics
NPI:1902684020
Name:FRIERA, MAURICE NICOLUS (RADT-I)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:NICOLUS
Last Name:FRIERA
Suffix:
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3847
Mailing Address - Country:US
Mailing Address - Phone:650-255-2550
Mailing Address - Fax:
Practice Address - Street 1:631 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3847
Practice Address - Country:US
Practice Address - Phone:650-255-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1487391122101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)