Provider Demographics
NPI:1871209874
Name:FELICIANO, ANTOHNY W
Entity type:Individual
Prefix:
First Name:ANTOHNY
Middle Name:W
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16932 S CALLIE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6814
Mailing Address - Country:US
Mailing Address - Phone:787-568-0302
Mailing Address - Fax:
Practice Address - Street 1:9007 SAFE HAVEN PL
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6420
Practice Address - Country:US
Practice Address - Phone:630-566-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker