Provider Demographics
NPI:1902953359
Name:FEDER, JUNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:E
Last Name:FEDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 73RD ST
Mailing Address - Street 2:3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2911
Mailing Address - Country:US
Mailing Address - Phone:212-724-4207
Mailing Address - Fax:212-877-4935
Practice Address - Street 1:315 W 57TH ST
Practice Address - Street 2:410
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3158
Practice Address - Country:US
Practice Address - Phone:212-877-4935
Practice Address - Fax:212-877-4935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0008737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146928OtherVALUE OPTIONS
NY0009428OtherGHIBMP
NYV51221Medicare ID - Type Unspecified