Healthcare Provider Details

I. General information

NPI: 1467421701
Provider Name (Legal Business Name): REGINE FELDMAN MSW LCSW BCD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 ASHDALE LANE
STUDIO CITY CA
91604-4201
US

IV. Provider business mailing address

11940 ASHDALE LANE
STUDIO CITY CA
91604-4201
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-9102
  • Fax: 310-657-1686
Mailing address:
  • Phone: 818-986-9102
  • Fax: 310-657-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS8646
License Number StateCA

VIII. Authorized Official

Name: MS. REGINE ROCHELLE FELDMAN
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 818-986-9102