Provider Demographics
NPI:1912337296
Name:FELDSTEIN EWING, SARAH W (PHD)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:W
Last Name:FELDSTEIN EWING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:W
Other - Last Name:FELDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:195 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1700
Mailing Address - Country:US
Mailing Address - Phone:860-679-1037
Mailing Address - Fax:
Practice Address - Street 1:65 KANE ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2110
Practice Address - Country:US
Practice Address - Phone:503-494-6176
Practice Address - Fax:503-494-6152
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4813103TC2200X
OR2596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500684987Medicaid