Healthcare Provider Details

I. General information

NPI: 1205066883
Provider Name (Legal Business Name): JESSICA FELICIANO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE BRACELAND BUILDING/INSTITUTE OF LIVING
HARTFORD CT
06106-3309
US

IV. Provider business mailing address

200 RETREAT AVE BRACELAND BUILDING/INSTITUTE OF LIVING
HARTFORD CT
06106-3309
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-0020
  • Fax:
Mailing address:
  • Phone: 860-696-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3812
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: