Provider Demographics
NPI:1902124290
Name:BERNARD FELDMAN, PHD A PSY CORP
Entity type:Organization
Organization Name:BERNARD FELDMAN, PHD A PSY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-377-7976
Mailing Address - Street 1:6572 EDDINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3166
Mailing Address - Country:US
Mailing Address - Phone:310-377-7976
Mailing Address - Fax:
Practice Address - Street 1:6572 EDDINGHILL DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3166
Practice Address - Country:US
Practice Address - Phone:310-377-7976
Practice Address - Fax:310-541-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3672261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health