Provider Demographics
NPI:1538464417
Name:FELVER, JOSHUA CHARLES (PHD ABPP)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CHARLES
Last Name:FELVER
Suffix:
Gender:M
Credentials:PHD ABPP
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:CHARLES
Other - Last Name:FELVER-GANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:120 E BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4266
Mailing Address - Country:US
Mailing Address - Phone:607-233-4337
Mailing Address - Fax:
Practice Address - Street 1:120 E BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4266
Practice Address - Country:US
Practice Address - Phone:607-233-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021949103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021949OtherNEW YORK STATE PSYCHOLOGIST REGISTRATION NUMBER