Healthcare Provider Details

I. General information

NPI: 1265569529
Provider Name (Legal Business Name): MARYANN FELDSTEIN EDD RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 EAST 74 STREET
NEW YORK NY
10021
US

IV. Provider business mailing address

174 EAST 74TH STREET
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-879-0753
  • Fax:
Mailing address:
  • Phone: 212-879-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1764961
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0002031
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number1764961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: