Provider Demographics
NPI:1427459742
Name:FELDMANN, MARY B (LPCC, LICDC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:FELDMANN
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 CARVER WOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5535
Mailing Address - Country:US
Mailing Address - Phone:513-793-3661
Mailing Address - Fax:513-793-3661
Practice Address - Street 1:4424 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-300-3667
Practice Address - Fax:513-793-3661
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.131018101YA0400X
OHE.1000047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074946OtherOHIO DEPARTMENT MENTAL HEALTH (ODMH)
OH01-0693OtherCARF CERTIFICATION
OH0074861OtherOHIO DEPARTMENT ALCOHOL DRUG SERVICES (ODADAS)
OH0074946OtherOHIO DEPARTMENT MENTAL HEALTH (ODMH)