Provider Demographics
NPI:1306236401
Name:FELICIA R. NEUBAUER, M.S.W.,L.C.S.W.,L.L.C.
Entity type:Organization
Organization Name:FELICIA R. NEUBAUER, M.S.W.,L.C.S.W.,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:856-596-4062
Mailing Address - Street 1:205 TUCKERTON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8817
Mailing Address - Country:US
Mailing Address - Phone:856-596-4062
Mailing Address - Fax:856-596-4063
Practice Address - Street 1:205 TUCKERTON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8817
Practice Address - Country:US
Practice Address - Phone:856-596-4062
Practice Address - Fax:856-596-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC45361001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty