Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301005034 | MI |
N | 103T00000X | Psychologist | 6301005034 | MI |
N | 103TA0700X | Adult Development & Aging Psychologist | 6301005034 | MI |
Y | 103G00000X | Clinical Psychologist | 6301005034 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301005034 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301005034 | MI |
N | 103TF0000X | Family Psychologist | 6301005034 | MI |
N | 103TF0200X | Forensic Psychologist | ||
N | 103TF0200X | Forensic Psychologist | 6301005034 | MI |
NPI | 1053486142 |
---|---|
Provider Name | Larry Mark Friedberg |
First Address | Bingham Farms, MI 48025-4372 |
Second Address | Bingham Farms, MI 48025-4372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 27/12/2019 |