Provider Demographics
NPI:1063609865
Name:FELDMAN, SCOTT ILAN (PHD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ILAN
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HADLEY HWY APT 1
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:NH
Mailing Address - Zip Code:03084-4539
Mailing Address - Country:US
Mailing Address - Phone:603-933-3876
Mailing Address - Fax:
Practice Address - Street 1:23 HADLEY HWY APT 1
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:NH
Practice Address - Zip Code:03084-4539
Practice Address - Country:US
Practice Address - Phone:603-933-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28567103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist