Provider Demographics
NPI:1295571818
Name:FELDMAN, EZRA Z (LPA)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:Z
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 SUMMERSON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2515
Mailing Address - Country:US
Mailing Address - Phone:443-380-3954
Mailing Address - Fax:
Practice Address - Street 1:1501 SULGRAVE AVE STE 100A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3675
Practice Address - Country:US
Practice Address - Phone:443-257-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional