Provider Demographics
NPI:1922877513
Name:FELT, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FELT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:NACHI
Other - Middle Name:
Other - Last Name:FELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:14740 76TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3118
Mailing Address - Country:US
Mailing Address - Phone:917-745-6185
Mailing Address - Fax:
Practice Address - Street 1:14715 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1719
Practice Address - Country:US
Practice Address - Phone:610-207-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026235103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty