Provider Demographics
NPI:1376964601
Name:FELICIE-MEJIAS, JOSE R (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:FELICIE-MEJIAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:FELICIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1776 CONTINENTAL DR UNIT 109
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7279
Mailing Address - Country:US
Mailing Address - Phone:939-717-3235
Mailing Address - Fax:
Practice Address - Street 1:AVE IRLANDA HTS
Practice Address - Street 2:FM 17 SIRIO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5359
Practice Address - Country:US
Practice Address - Phone:939-717-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2971103TC0700X
LA15713171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical