Provider Demographics
NPI:1902810153
Name:FRIEDMAN, ANDREA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14627 VILLAGE GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2733
Mailing Address - Country:US
Mailing Address - Phone:813-928-6895
Mailing Address - Fax:
Practice Address - Street 1:12169 W LINEBAUGH AVE
Practice Address - Street 2:WESTCHASE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1732
Practice Address - Country:US
Practice Address - Phone:813-928-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6274103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5122AMedicare ID - Type UnspecifiedPSYCHOLOGIST