Provider Demographics
NPI:1740528850
Name:FELDMAN, MATTHEW (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 GILDERSLEEVE ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2504
Mailing Address - Country:US
Mailing Address - Phone:917-968-5384
Mailing Address - Fax:
Practice Address - Street 1:1736 GILDERSLEEVE ST
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2504
Practice Address - Country:US
Practice Address - Phone:917-968-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical