Provider Demographics
NPI:1629136627
Name:FEIST, JERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:FEIST
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 1:9345 KINGTOWN BEACH RD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9235
Mailing Address - Country:US
Mailing Address - Phone:607-277-4131
Mailing Address - Fax:607-387-3625
Practice Address - Street 1:109 E SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4307
Practice Address - Country:US
Practice Address - Phone:607-277-4131
Practice Address - Fax:607-387-3625
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health