Provider Demographics
NPI:1881817534
Name:FELDMAN, PAUL JOEL
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOEL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MS
Mailing Address - Street 1:1020 SW TAYLOR ST
Mailing Address - Street 2:SUITE 441
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2543
Mailing Address - Country:US
Mailing Address - Phone:503-241-9114
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:SUITE 441
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2543
Practice Address - Country:US
Practice Address - Phone:503-241-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0427103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist