Provider Demographics
NPI:1962812990
Name:FELDER, CALVIN JR
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
Last Name:FELDER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 MARSOL RD APT 642
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3507
Mailing Address - Country:US
Mailing Address - Phone:216-931-0140
Mailing Address - Fax:
Practice Address - Street 1:6503 MARSOL RD APT 642
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3507
Practice Address - Country:US
Practice Address - Phone:216-931-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.0000123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist