Provider Demographics
NPI:1043831118
Name:FELDMAN, CAROL G (PHD,JD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:G
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PHD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RUTLANDSQUARE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-266-5277
Mailing Address - Fax:
Practice Address - Street 1:23 RUTLAND SQ
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3105
Practice Address - Country:US
Practice Address - Phone:617-266-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2328103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic