Provider Demographics
NPI:1699968024
Name:FELTOVICH, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FELTOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 WARFIELD AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1602
Mailing Address - Country:US
Mailing Address - Phone:510-846-2124
Mailing Address - Fax:
Practice Address - Street 1:7901 OAKPORT ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2015
Practice Address - Country:US
Practice Address - Phone:510-613-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health