Provider Demographics
NPI:1639794159
Name:FELICIANO, JANNELLE
Entity Type:Individual
Prefix:
First Name:JANNELLE
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE DUKE #901 UNIVERSITY GARDENS
Mailing Address - Street 2:APT. B- 3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4834
Mailing Address - Country:US
Mailing Address - Phone:787-222-4820
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA FIDALGO DIAZ
Practice Address - Street 2:#CL3 VIA EMILIA, VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-222-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3418103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling