Provider Demographics
NPI:1346339629
Name:FEINSILBER, MARK P (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:FEINSILBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:AFFILIATED
Other - Middle Name:PSYCHOLOGICAL
Other - Last Name:SERVICES, PC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6030 BETHELVIEW RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8020
Mailing Address - Country:US
Mailing Address - Phone:770-205-5760
Mailing Address - Fax:770-205-5780
Practice Address - Street 1:6030 BETHELVIEW RD
Practice Address - Street 2:SUITE 401
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8020
Practice Address - Country:US
Practice Address - Phone:770-205-5760
Practice Address - Fax:770-205-5780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581832456OtherTAX I.D.