Provider Demographics
NPI:1871891994
Name:FELDMAN, MARC LAUD (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:LAUD
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALLENDALE LN
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1902
Mailing Address - Country:US
Mailing Address - Phone:610-675-5517
Mailing Address - Fax:
Practice Address - Street 1:111 FORREST AVE FL 2
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2252
Practice Address - Country:US
Practice Address - Phone:610-675-5517
Practice Address - Fax:484-409-1676
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016917103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12213541OtherCAQH