Provider Demographics
NPI:1952555930
Name:FELIZARDO, DANIEL ANDREW (CDP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:FELIZARDO
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 E 32ND ST BLDG 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4922
Mailing Address - Country:US
Mailing Address - Phone:253-593-0291
Mailing Address - Fax:253-441-2710
Practice Address - Street 1:2209 E 32ND ST
Practice Address - Street 2:BLDG 3
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4922
Practice Address - Country:US
Practice Address - Phone:253-593-0291
Practice Address - Fax:253-441-2710
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60025733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)