Provider Demographics
NPI:1336837194
Name:FELICIANO, MELIZA LEONOR (LGPC)
Entity Type:Individual
Prefix:
First Name:MELIZA
Middle Name:LEONOR
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21713 ACADEMY LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1801
Mailing Address - Country:US
Mailing Address - Phone:515-401-2649
Mailing Address - Fax:
Practice Address - Street 1:322 E ANTIETAM ST STE 307A
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5750
Practice Address - Country:US
Practice Address - Phone:240-513-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional