Provider Demographics
NPI:1740495795
Name:FELDMAN, ROGER LEWIS (ROGER FELDMAN, MS)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEWIS
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:ROGER FELDMAN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HIGH AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2102
Mailing Address - Country:US
Mailing Address - Phone:845-358-2119
Mailing Address - Fax:
Practice Address - Street 1:48 W 21ST ST
Practice Address - Street 2:SUITE 3F-301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6907
Practice Address - Country:US
Practice Address - Phone:212-206-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000709OtherMENTAL HEALTH COUNSELOR