Provider Demographics
NPI:1003363987
Name:FELICIANO, ANA DOLORES (LMHC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:DOLORES
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PLEASANT ST APT C
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2795
Mailing Address - Country:US
Mailing Address - Phone:413-667-7075
Mailing Address - Fax:
Practice Address - Street 1:113 PLEASANT ST APT C
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2795
Practice Address - Country:US
Practice Address - Phone:413-667-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12004101YM0800X
PR5664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12004OtherLMHC 12004