Provider Demographics
NPI:1891166591
Name:PAMELA FELDMAN, PHD LLC
Entity Type:Organization
Organization Name:PAMELA FELDMAN, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-385-9434
Mailing Address - Street 1:6510 NW 74TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3927
Mailing Address - Country:US
Mailing Address - Phone:561-385-9434
Mailing Address - Fax:
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:SUITE 216A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-385-9434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS167636Medicare UPIN