Provider Demographics
NPI:1255766929
Name:FELIX, MARK ALVIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALVIN
Last Name:FELIX
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MONTAGUE RD
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9585
Mailing Address - Country:US
Mailing Address - Phone:413-695-1826
Mailing Address - Fax:
Practice Address - Street 1:55 MONTAGUE RD
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9585
Practice Address - Country:US
Practice Address - Phone:413-695-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY-6573103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist