Provider Demographics
NPI:1538545363
Name:FRIEDMAN, ELLEN (MSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3601 LAKE MARY ROAD
Mailing Address - Street 2:APT. 382
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005
Mailing Address - Country:US
Mailing Address - Phone:404-664-1880
Mailing Address - Fax:
Practice Address - Street 1:13055 WEST MCDOWELL RD
Practice Address - Street 2:G-112
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:623-792-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical