Provider Demographics
NPI:1841356896
Name:FELSEN, IRIT VITA (PHD)
Entity type:Individual
Prefix:DR
First Name:IRIT
Middle Name:VITA
Last Name:FELSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:IRIT
Other - Middle Name:
Other - Last Name:FELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LLC
Mailing Address - Street 1:550 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005
Mailing Address - Country:US
Mailing Address - Phone:973-541-9900
Mailing Address - Fax:973-263-3547
Practice Address - Street 1:550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:973-541-9900
Practice Address - Fax:973-263-3547
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical