MEDICARE: ADAM FEDER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY6660	FL
2	103TC1900X	Counseling Psychologist	PY6660	FL
3	103TC2200X	Clinical Child & Adolescent Psychologist	PY6660	FL
4	103T00000X	Psychologist	PY6660	FL

General Provider Information

NPI Number	:	1033107537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM FEDER PSYD

Provider Business Mailing Address
First Line	:	751 NE 195TH ST
Second Line	:	3102
City	:	MIAMI
State	:	FL
Zip	:	33175
Country	:	US
Telephone Number	:	305-962-0274
Fax Number	:	305-653-4551

Provider Business Practice Location Address
First Line	:	5451 NORTH UNIVERSITY DR
Second Line	:	SUITE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067
Country	:	US
Telephone Number	:	305-962-0274
Fax Number	:	305-653-4551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	09/11/2025

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Directions to “ ADAM FEDER PSYD” Practice Location

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