MEDICARE: LEONARD CARL FELDER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY13448	CA

General Provider Information

NPI Number	:	1073531059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD CARL FELDER PH.D.

Provider Business Mailing Address
First Line	:	2566 OVERLAND AVE STE 780
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3371
Country	:	US
Telephone Number	:	310-815-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 OVERLAND AVE STE 780
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3371
Country	:	US
Telephone Number	:	310-815-1611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/09/2007

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