Provider Demographics
NPI:1841015740
Name:FEIGENBAUM, JEREMY KARL (AMFT, MA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:KARL
Last Name:FEIGENBAUM
Suffix:
Gender:M
Credentials:AMFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 H ST APT 12
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2299
Mailing Address - Country:US
Mailing Address - Phone:512-909-9774
Mailing Address - Fax:
Practice Address - Street 1:2050 PEABODY RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6695
Practice Address - Country:US
Practice Address - Phone:707-446-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145319106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist