Provider Demographics
NPI:1801668819
Name:FERICELLI, PAUL
Entity type:Individual
Prefix:PROF
First Name:PAUL
Middle Name:
Last Name:FERICELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PASEO VIEJO SAN JUAN
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-8903
Mailing Address - Country:US
Mailing Address - Phone:787-585-3278
Mailing Address - Fax:
Practice Address - Street 1:123 PASEO VIEJO SAN JUAN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-8903
Practice Address - Country:US
Practice Address - Phone:787-585-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10166104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker