Provider Demographics
NPI:1285471235
Name:FELICIANO, JOMARALYZ (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:JOMARALYZ
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB QUINTAS DE PLAZA AQUARIUM
Mailing Address - Street 2:CALLE MARLIN #96
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-243-2999
Mailing Address - Fax:
Practice Address - Street 1:URB QUINTAS DE PLAZA AQUARIUM
Practice Address - Street 2:CALLE MARLIN #96
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-243-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR168501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical