Provider Demographics
NPI:1750385266
Name:FEIERSTEIN, ROSLYN E (PHD)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:E
Last Name:FEIERSTEIN
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 1:1544 WINCHESTER AVE
Mailing Address - Street 2:STE 601
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7929
Mailing Address - Country:US
Mailing Address - Phone:606-325-4091
Mailing Address - Fax:606-325-4092
Practice Address - Street 1:1544 WINCHESTER AVE
Practice Address - Street 2:STE 601
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7929
Practice Address - Country:US
Practice Address - Phone:606-325-4091
Practice Address - Fax:606-325-4092
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY918103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00006891OtherRAILROAD MEDICARE
KYP00006891OtherRAILROAD MEDICARE
KY0748101Medicare ID - Type Unspecified