Provider Demographics
NPI:1871285056
Name:FELICIANA, JERRYE B (PHD, LCPC-S)
Entity type:Individual
Prefix:DR
First Name:JERRYE
Middle Name:B
Last Name:FELICIANA
Suffix:
Gender:F
Credentials:PHD, LCPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 ALLENTOWN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4564
Mailing Address - Country:US
Mailing Address - Phone:240-392-2876
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD STE 310
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4564
Practice Address - Country:US
Practice Address - Phone:240-392-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3160101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor