Provider Demographics
NPI:1720418452
Name:FELTON, JUDITH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FELTON
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 1:215 W 90TH ST
Mailing Address - Street 2:APT 12F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1221
Mailing Address - Country:US
Mailing Address - Phone:212-724-5117
Mailing Address - Fax:
Practice Address - Street 1:215 W 90TH ST
Practice Address - Street 2:APT 12F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1221
Practice Address - Country:US
Practice Address - Phone:212-724-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLRP012620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health