Provider Demographics
NPI:1689248361
Name:FEINBERG, JUSTIN R (MA, MDIV)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:R
Last Name:FEINBERG
Suffix:
Gender:M
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 HALF DAY RD # T-742
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1241
Mailing Address - Country:US
Mailing Address - Phone:631-456-1137
Mailing Address - Fax:
Practice Address - Street 1:1100 E WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7963
Practice Address - Country:US
Practice Address - Phone:847-438-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional