Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSYPAT00194928 | KY |
NPI | 1114328309 |
---|---|
Provider Name | Joshua Feldblyum |
First Address | Philadelphia, PA 19146-3900 |
Second Address | Philadelphia, PA 19146-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 26/02/2019 |