Healthcare Provider Details

I. General information

NPI: 1629903075
Provider Name (Legal Business Name): JESSICA FELDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 PARKER HILL AVE
BOSTON MA
02120-3225
US

IV. Provider business mailing address

30 GARRISON ST
BOSTON MA
02116-5741
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-8390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: