Provider Demographics
NPI:1679169080
Name:FELSKE, EMILY (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FELSKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 DUCK HOLE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2536
Mailing Address - Country:US
Mailing Address - Phone:847-772-8719
Mailing Address - Fax:
Practice Address - Street 1:341 WEST STREET
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06479-0647
Practice Address - Country:US
Practice Address - Phone:847-772-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.004665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT46.004665Medicaid