Provider Demographics
NPI:1548366636
Name:FRIEDER, SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FRIEDER
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 1:2200 MAIN ST STE 510
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1624
Mailing Address - Country:US
Mailing Address - Phone:808-243-0888
Mailing Address - Fax:808-875-8288
Practice Address - Street 1:2200 MAIN ST STE 510
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1624
Practice Address - Country:US
Practice Address - Phone:808-243-0888
Practice Address - Fax:808-875-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI049851-01Medicaid
HI4107Medicare UPIN
HI192850-1 1Medicare UPIN
HI4026Medicare UPIN
HI000179Medicare UPIN