Provider Demographics
NPI:1770613127
Name:FEDER, PAUL AUGIE (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:AUGIE
Last Name:FEDER
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DWIGHT WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2639
Mailing Address - Country:US
Mailing Address - Phone:510-984-2499
Mailing Address - Fax:
Practice Address - Street 1:2000 DWIGHT WAY
Practice Address - Street 2:SUITE D
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2639
Practice Address - Country:US
Practice Address - Phone:510-984-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47064106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist