Provider Demographics
NPI:1780742551
Name:FRIEDMAN, ANN M (LCMI C)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LCMI C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 MAIN ST
Mailing Address - Street 2:MANCHESTER CENTER
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:802-362-2334
Mailing Address - Fax:
Practice Address - Street 1:90 MAHONEY AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-2581
Practice Address - Fax:802-775-3395
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT08049515OtherBCBS
VT1007398Medicaid
VT75394OtherMVP