Provider Demographics
NPI:1801122791
Name:FRIEDMAN, LESLIE ANN
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5204
Mailing Address - Country:US
Mailing Address - Phone:718-364-9700
Mailing Address - Fax:718-365-3670
Practice Address - Street 1:2432 GRAND CONCOURSE
Practice Address - Street 2:SUITE 505
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-364-9700
Practice Address - Fax:718-365-3670
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245029Medicaid