Provider Demographics
NPI:1720836141
Name:KENNETH FELDSTEIN LADC1 - LLC
Entity Type:Organization
Organization Name:KENNETH FELDSTEIN LADC1 - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC1
Authorized Official - Phone:617-615-6306
Mailing Address - Street 1:8 BASSETT BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-248-3030
Mailing Address - Fax:
Practice Address - Street 1:36 NO. BEDFORD STREET
Practice Address - Street 2:C22
Practice Address - City:E. BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1186
Practice Address - Country:US
Practice Address - Phone:616-615-6306
Practice Address - Fax:774-221-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty