MEDICARE: DR. MADELINE LICKER FEINGOLD PH.D.

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	101YM0800X	Mental Health Counselor	PSY9071	CA

General Provider Information

NPI Number	:	1538180948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELINE LICKER FEINGOLD PH.D.

Provider Business Mailing Address
First Line	:	1491 HOPKINS ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1244
Country	:	US
Telephone Number	:	510-540-8715
Fax Number	:	510-527-6851

Provider Business Practice Location Address
First Line	:	1491 HOPKINS ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1244
Country	:	US
Telephone Number	:	510-540-8715
Fax Number	:	510-527-6851

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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