Provider Demographics
NPI:1952611923
Name:FELDMAN, AUDREY L (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:L
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440-14 WAVERLY AVENUE
Mailing Address - Street 2:WAVERLY AVENUE CLINIC
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-654-2077
Mailing Address - Fax:631-654-8376
Practice Address - Street 1:440-14 WAVERLY AVENUE
Practice Address - Street 2:WAVERLY AVENUE CLINIC
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-654-2077
Practice Address - Fax:631-654-8376
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007558-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical