Healthcare Provider Details

I. General information

NPI: 1467512269
Provider Name (Legal Business Name): LUIS MANUEL FELIX MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JEFFERSON ST
HARTFORD CT
06106-5035
US

IV. Provider business mailing address

106 JUDD ST
BRISTOL CT
06010-4346
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-1124
  • Fax: 860-724-2539
Mailing address:
  • Phone: 860-261-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: