Provider Demographics
NPI:1952750176
Name:FELDMAN, ALICIA (LMHC, CASAC)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9508 QUEENS BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1152
Mailing Address - Country:US
Mailing Address - Phone:917-408-3899
Mailing Address - Fax:
Practice Address - Street 1:7405 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2636
Practice Address - Country:US
Practice Address - Phone:917-408-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997148Medicaid