Provider Demographics
NPI:1538724976
Name:FELICIANO, DAMARIS (LSW)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 W 26TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2708
Mailing Address - Country:US
Mailing Address - Phone:201-314-1804
Mailing Address - Fax:
Practice Address - Street 1:53 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-7023
Practice Address - Country:US
Practice Address - Phone:201-422-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06369300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker