Active NPI
Jonathan Friedman, M.A.
- Mental Health Counselor
- San Diego, CA
National Provider Identifier
1457404113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 734 10TH Ave
San Diego, CA 92101-6502 - Phone
- (619) 239-4663
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY12323 | FL | |
| Mental Health Counselor | 101YM0800X | Primary | ||
| Psychologist | 103T00000X | PY12323 | FL |
Addresses
Primary practice location
734 10TH Ave
San Diego, CA 92101-6502
Mailing address
PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-6050
Other practice location 1
15901 Bass Rd Ste 102
Fort Myers, FL 33908-3838
Phone (239) 343-6050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY12323 | FL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lee Health System Inc | Current | Accepting new patients | |
| Lee Health System Inc | Current | Accepting new patients | |
| Community Research Foundation Inc | Past | Accepting new patients | |
| Community Research Foundation Inc | Clinical | Past | Accepting new patients |
Locations
1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900
15901 Bass Rd
Ste 102
Fort Myers, FL 33908
Phone (239) 343-9890
Networks
- Freedom Health HMO Network
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Fort Myers, FL
- NPI 1942058557
-
- Community/Retail Pharmacy
- Bonita Springs, FL
- NPI 1699510925
-
- Community/Behavioral Health Agency
- San Diego, CA
- NPI 1346463932
-
- Community/Behavioral Health Agency
- San Diego, CA
- NPI 1952328700
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740700800000",
"number": "1457404113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2147",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339022147",
"telephone_number": "239-343-6050",
"fax_number": "239-343-6051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "734 10TH AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921016502",
"telephone_number": "619-239-4663"
}
],
"practiceLocations": [
{
"address_1": "15901 Bass Rd Ste 102",
"address_purpose": "LOCATION",
"city": "Fort Myers",
"state": "FL",
"postal_code": "339083838",
"country_code": "US",
"telephone_number": "239-343-6050",
"fax_number": "239-343-6051",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FRIEDMAN",
"first_name": "JONATHAN",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2025-02-28",
"certification_date": "2025-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY12323",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY12323",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.