Provider Demographics
NPI:1780684605
Name:FEO, ANTONE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTONE
Middle Name:F
Last Name:FEO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EDGEWATER SQ
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1808
Mailing Address - Country:US
Mailing Address - Phone:216-226-8826
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5601
Practice Address - Country:US
Practice Address - Phone:440-899-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-10-31
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
OH4000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0698080Medicaid
OH0698080Medicaid