Provider Demographics
NPI:1245270057
Name:FEIMAN, JUDITH R (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:R
Last Name:FEIMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 GATEWAY
Mailing Address - Street 2:STE 104
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1893
Mailing Address - Country:US
Mailing Address - Phone:513-234-7870
Mailing Address - Fax:513-234-7836
Practice Address - Street 1:5740 GATEWAY
Practice Address - Street 2:STE 104
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1893
Practice Address - Country:US
Practice Address - Phone:513-234-7870
Practice Address - Fax:513-234-7836
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0339959Medicaid
OHCP05599Medicare PIN