Provider Demographics
NPI:1063739811
Name:FELICIANO, EILEEN MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARIE
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 BAY RIDGE PKWY
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3309
Mailing Address - Country:US
Mailing Address - Phone:718-551-4796
Mailing Address - Fax:
Practice Address - Street 1:551 BAY RIDGE PKWY
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3309
Practice Address - Country:US
Practice Address - Phone:718-551-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018252103TC0700X
NY818208103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool