Provider Demographics
NPI:1710126305
Name:FELD, JOHN P (LCDP00450)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:FELD
Suffix:
Gender:M
Credentials:LCDP00450
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 THAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2536
Mailing Address - Country:US
Mailing Address - Phone:401-846-4150
Mailing Address - Fax:401-846-9340
Practice Address - Street 1:93 THAMES ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2536
Practice Address - Country:US
Practice Address - Phone:401-846-4150
Practice Address - Fax:401-846-9340
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00450101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILCDP00450OtherSTATE OF RHODE ISLAND