MEDICARE: PATRICIA C. FELDTMOSE M.S.

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	106H00000X	Marriage & Family Therapist	000775	CT

General Provider Information

NPI Number	:	1568543023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA C. FELDTMOSE M.S.

Provider Business Mailing Address
First Line	:	49 RIGGS AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2740
Country	:	US
Telephone Number	:	860-313-0069
Fax Number	:	860-313-0069

Provider Business Practice Location Address
First Line	:	1120 SILVER LN
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-1329
Country	:	US
Telephone Number	:	860-313-0069
Fax Number	:	860-313-0069

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/09/2007

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