Provider Demographics
NPI:1568180321
Name:FELICIANO, LILITHE P (CCMA)
Entity Type:Individual
Prefix:
First Name:LILITHE
Middle Name:P
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1051
Mailing Address - Country:US
Mailing Address - Phone:862-214-4337
Mailing Address - Fax:
Practice Address - Street 1:183 S ORANGE AVE # E1409
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-5430
Practice Address - Fax:973-972-7173
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ991372OtherNCCT