Healthcare Provider Details

I. General information

NPI: 1508641010
Provider Name (Legal Business Name): SCOTT FELDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HILLSIDE CIR
WEST SPRINGFIELD MA
01089-4679
US

IV. Provider business mailing address

332 BIRNIE AVE
SPRINGFIELD MA
01107-1104
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10006761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: