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General NPI Number Information
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NPI Number | 1912664939
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Entity Type | Individual
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Provider Name | MALLORIE LAURA GORDON FELSENFELD PHD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 10 CENTER DR RM 1C244
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City | BETHESDA
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State | MD
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Zip | 20892-0004
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Country | US
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Telephone | 240-760-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 11550 OLD GEORGETOWN RD APT 914
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City | NORTH BETHESDA
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State | MD
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Zip | 20852-2858
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Country | US
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Telephone | 917-882-8724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0000003640
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License Number State | TN
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