Healthcare Provider Details

I. General information

NPI: 1063825909
Provider Name (Legal Business Name): CAROLYNN EVA FELDBLUM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WOODLANE RD
WESTAMPTON NJ
08060-3804
US

IV. Provider business mailing address

358 WINDING WAY
MERION STATION PA
19066-1534
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5928
  • Fax:
Mailing address:
  • Phone: 610-668-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL05942900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW129225
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: