MEDICARE: DR. ELIZABETH F. FELDMAN 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	103TC0700X	Clinical Psychologist	071003782	IL

General Provider Information

NPI Number	:	1144213323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH F. FELDMAN PH.D.

Provider Business Mailing Address
First Line	:	778 W FRONTAGE RD
Second Line	:	SUITE 115
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-1209
Country	:	US
Telephone Number	:	847-501-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	778 W FRONTAGE RD
Second Line	:	SUITE 115
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-1209
Country	:	US
Telephone Number	:	847-501-3620
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/25/2016

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