Provider Demographics
NPI:1508285560
Name:JENKINS, FELTON
Entity Type:Individual
Prefix:
First Name:FELTON
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4545
Mailing Address - Country:US
Mailing Address - Phone:718-735-5966
Mailing Address - Fax:
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4545
Practice Address - Country:US
Practice Address - Phone:718-735-5966
Practice Address - Fax:718-735-5178
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)