Individual provider Active NPI

Jonathan Friedman, M.A.

  • Mental Health Counselor
  • San Diego, CA
National Provider Identifier
1457404113
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
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

Updated by the provider on Feb 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250117002071 FL Practitioner - Clinical Psychologist 9032485990 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
PY12323FLMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Feb 15, 2025 Accepting new patients
Lee Health System Inc CurrentSince Feb 15, 2025 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.

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

Verify at the official NPI Registry.