Provider Demographics
NPI:1104507284
Name:FELIZ, CARLOS J
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:FELIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 BRYANT AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-7415
Mailing Address - Country:US
Mailing Address - Phone:646-458-1248
Mailing Address - Fax:
Practice Address - Street 1:770 BRYANT AVE APT 5H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-7415
Practice Address - Country:US
Practice Address - Phone:646-458-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1715274231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst