Provider Demographics
NPI:1518010107
Name:FELDSTEIN, JEROME H (PHD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:H
Last Name:FELDSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:SUITE 670
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-933-9000
Mailing Address - Fax:410-933-9085
Practice Address - Street 1:8114 SANDPIPER CIR
Practice Address - Street 2:SUITE 215
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4934
Practice Address - Country:US
Practice Address - Phone:410-933-9000
Practice Address - Fax:410-933-9085
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist