Provider Demographics
NPI:1275693392
Name:FELDMAN, GAIL DIANE (PHD)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DIANE
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:CARR
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3200 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1600
Mailing Address - Country:US
Mailing Address - Phone:505-830-6061
Mailing Address - Fax:505-830-6062
Practice Address - Street 1:3200 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 106
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1600
Practice Address - Country:US
Practice Address - Phone:505-830-6061
Practice Address - Fax:505-830-6062
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical