Provider Demographics
NPI:1235658295
Name:PRIEDEMAN, GORDON (PSYD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:PRIEDEMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N FAIRFAX AVE UNIT 312
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7292
Mailing Address - Country:US
Mailing Address - Phone:213-700-2857
Mailing Address - Fax:
Practice Address - Street 1:801 N FAIRFAX AVE UNIT 312
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7292
Practice Address - Country:US
Practice Address - Phone:213-700-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36081103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health