Provider Demographics
NPI:1033227038
Name:FRIED, DAWN C (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:C
Last Name:FRIED
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BELLEVUE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:973-220-2464
Mailing Address - Fax:201-624-7157
Practice Address - Street 1:203 BELLEVUE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:973-220-2464
Practice Address - Fax:201-624-7157
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ136117Medicare ID - Type Unspecified