Healthcare Provider Details

I. General information

NPI: 1942244629
Provider Name (Legal Business Name): FELIX T VINCENZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 TOWERBRIDGE PL
SAINT CHARLES MO
63303-4800
US

IV. Provider business mailing address

29 TOWERBRIDGE PL
SAINT CHARLES MO
63303-4800
US

V. Phone/Fax

Practice location:
  • Phone: 573-808-4462
  • Fax:
Mailing address:
  • Phone: 573-808-4462
  • Fax: 314-877-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY01157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: