Provider Demographics
NPI:1073829644
Name:FELICIANO, MARIA J (MA PSY)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 INDO STREET, EL CEREZAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3032
Mailing Address - Country:US
Mailing Address - Phone:787-764-4534
Mailing Address - Fax:
Practice Address - Street 1:I-4 BETANCES AVE., HERMANAS DAVILA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-7061
Practice Address - Country:US
Practice Address - Phone:787-740-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1492103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist