Provider Demographics
NPI:1124131909
Name:FELD, MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FELD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 E 103 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4503
Mailing Address - Country:US
Mailing Address - Phone:347-248-1092
Mailing Address - Fax:718-444-8560
Practice Address - Street 1:1349 E 103 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4503
Practice Address - Country:US
Practice Address - Phone:347-248-1092
Practice Address - Fax:718-444-8560
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0414491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP918182OtherOXFORD
NY01804773Medicaid
NY0R041449OtherMETRO PLUS
NY01804773Medicaid