Provider Demographics
NPI:1700659356
Name:FELICIANA, JEFFRAY (LPC)
Entity type:Individual
Prefix:
First Name:JEFFRAY
Middle Name:
Last Name:FELICIANA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E CATHEDRAL RD
Mailing Address - Street 2:STE 45 #3003
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-440-6591
Mailing Address - Fax:
Practice Address - Street 1:AYO 19
Practice Address - Street 2:
Practice Address - City:PARADERA
Practice Address - State:PARADERA
Practice Address - Zip Code:00000
Practice Address - Country:AW
Practice Address - Phone:215-440-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional