Provider Demographics
NPI:1922129113
Name:FELICE, DONALD (BA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FELICE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 TISCH WAY STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2530
Mailing Address - Country:US
Mailing Address - Phone:831-235-1402
Mailing Address - Fax:831-535-5449
Practice Address - Street 1:3031 TISCH WAY STE 306
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2530
Practice Address - Country:US
Practice Address - Phone:831-235-1402
Practice Address - Fax:831-535-5449
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional