MEDICARE: FELICITY ANNE LODGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1891575130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICITY ANNE LODGE

Provider Business Mailing Address
First Line	:	33 W 60TH ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7905
Country	:	US
Telephone Number	:	646-977-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 W 60TH ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7905
Country	:	US
Telephone Number	:	646-977-1137
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	06/11/2026

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Directions to “ FELICITY ANNE LODGE ” Practice Location

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