Provider Demographics
NPI:1982075222
Name:FELICIANO, TAKIA (MS CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:TAKIA
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MS CASAC-T
Other - Prefix:
Other - First Name:TAKIA
Other - Middle Name:
Other - Last Name:CABALLERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:280 CORNELIA ST APT 315
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2328
Mailing Address - Country:US
Mailing Address - Phone:518-250-8637
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5900
Practice Address - Country:US
Practice Address - Phone:518-561-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31674 CASAC-T101YA0400X
NYP98585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)