Healthcare Provider Details

I. General information

NPI: 1235577503
Provider Name (Legal Business Name): BETH ANNE NEWMAN FELDMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 BLUE FEBRUARY WAY
COLUMBIA MD
21044-4416
US

IV. Provider business mailing address

11912 BLUE FEBRUARY WAY
COLUMBIA MD
21044-4416
US

V. Phone/Fax

Practice location:
  • Phone: 202-744-3436
  • Fax:
Mailing address:
  • Phone: 202-744-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number05074
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: