Provider Demographics
NPI:1881794261
Name:FELDMAN-KINGSBURY, JUDITH LESLIE (LICSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LESLIE
Last Name:FELDMAN-KINGSBURY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-4007
Mailing Address - Country:US
Mailing Address - Phone:508-481-5663
Mailing Address - Fax:508-473-6644
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04461Medicare ID - Type Unspecified