Provider Demographics
NPI:1538761366
Name:FELD, SHULAMIT
Entity type:Individual
Prefix:
First Name:SHULAMIT
Middle Name:
Last Name:FELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1648
Mailing Address - Country:US
Mailing Address - Phone:203-768-0250
Mailing Address - Fax:
Practice Address - Street 1:50 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1648
Practice Address - Country:US
Practice Address - Phone:203-768-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-19-39621103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst