Provider Demographics
NPI:1205817152
Name:FELZEN, SALLI (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SALLI
Middle Name:
Last Name:FELZEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3272
Mailing Address - Country:US
Mailing Address - Phone:212-288-3537
Mailing Address - Fax:
Practice Address - Street 1:110 E 71ST ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5063
Practice Address - Country:US
Practice Address - Phone:212-288-3537
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0137531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2116178OtherOXFORD
P2116178OtherOXFORD