Provider Demographics
NPI:1568543023
Name:FELDTMOSE, PATRICIA C (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:FELDTMOSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2740
Mailing Address - Country:US
Mailing Address - Phone:860-313-0069
Mailing Address - Fax:860-313-0069
Practice Address - Street 1:1120 SILVER LN
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1329
Practice Address - Country:US
Practice Address - Phone:860-313-0069
Practice Address - Fax:860-313-0069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist