Provider Demographics
NPI:1700188570
Name:FELDMAN, SANDRA LEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MI
Mailing Address - Zip Code:49116-0057
Mailing Address - Country:US
Mailing Address - Phone:269-921-2953
Mailing Address - Fax:
Practice Address - Street 1:820 LESTER AVE
Practice Address - Street 2:SUITE B10
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2561
Practice Address - Country:US
Practice Address - Phone:269-921-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010926801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical