Provider Demographics
NPI:1356899066
Name:FRIED, THOMAS (EDD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73188
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20056-3188
Mailing Address - Country:US
Mailing Address - Phone:202-341-0500
Mailing Address - Fax:877-637-7491
Practice Address - Street 1:1100 VERMONT AVE NW
Practice Address - Street 2:520
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-6327
Practice Address - Country:US
Practice Address - Phone:240-670-8367
Practice Address - Fax:877-637-7491
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSY1001150103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist