Provider Demographics
NPI:1992860696
Name:FELDSTEIN, JOANN (ED D)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:FELDSTEIN
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2425
Mailing Address - Country:US
Mailing Address - Phone:617-332-9887
Mailing Address - Fax:617-969-9238
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:401C
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-332-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2776103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50762Medicare ID - Type Unspecified
MA02370Medicare PIN