Healthcare Provider Details

I. General information

NPI: 1609687060
Provider Name (Legal Business Name): LISA RENEE FELDMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MERCER RD
MERION STATION PA
19066-1015
US

IV. Provider business mailing address

515 MERCER RD
MERION STATION PA
19066-1015
US

V. Phone/Fax

Practice location:
  • Phone: 609-828-3132
  • Fax:
Mailing address:
  • Phone: 609-828-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016770
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: