Provider Demographics
NPI:1598877227
Name:FELDSTEIN, SHIRLEY (MSW CSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:FELDSTEIN
Suffix:
Gender:F
Credentials:MSW CSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MERCEDES ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-692-1371
Mailing Address - Fax:
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:VANTAGE HEALTH SYSTEM
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628
Practice Address - Country:US
Practice Address - Phone:201-385-4400
Practice Address - Fax:201-384-7067
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC012916001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005908GRPMedicaid
NJ698239C2RMedicare PIN