Healthcare Provider Details

I. General information

NPI: 1710126305
Provider Name (Legal Business Name): JOHN P FELD LCDP00450
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 THAMES ST
NEWPORT RI
02840-2536
US

IV. Provider business mailing address

93 THAMES ST
NEWPORT RI
02840-2536
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-4150
  • Fax: 401-846-9340
Mailing address:
  • Phone: 401-846-4150
  • Fax: 401-846-9340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP00450
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: