Provider Demographics
NPI:1578814372
Name:FELDMAN, AVIEL (LCPC)
Entity Type:Individual
Prefix:
First Name:AVIEL
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 LIGHTFOOT DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1536
Mailing Address - Country:US
Mailing Address - Phone:718-501-8855
Mailing Address - Fax:
Practice Address - Street 1:2510 LIGHTFOOT DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1536
Practice Address - Country:US
Practice Address - Phone:718-501-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD067676400Medicaid