MEDICARE: MR. CALVIN FELDER JR.

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	F.0000123	OH

General Provider Information

NPI Number	:	1962812990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CALVIN FELDER JR.

Provider Business Mailing Address
First Line	:	6503 MARSOL RD APT 642
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3507
Country	:	US
Telephone Number	:	216-931-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 MARSOL RD APT 642
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-3507
Country	:	US
Telephone Number	:	216-931-0140
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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