Provider Demographics
NPI:1356463400
Name:FELICIANO, WILFREDO SR (BA, LADAC1,CAS)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:
Last Name:FELICIANO
Suffix:SR
Gender:M
Credentials:BA, LADAC1,CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 JOHN DUGGAN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1555
Mailing Address - Country:US
Mailing Address - Phone:401-625-1126
Mailing Address - Fax:
Practice Address - Street 1:22 FRONT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4302
Practice Address - Country:US
Practice Address - Phone:508-676-1307
Practice Address - Fax:508-674-4493
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALADAC1-1333,CAS-4357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)