Healthcare Provider Details

I. General information

NPI: 1174093488
Provider Name (Legal Business Name): BOBBY E FELICIE MR.FELICIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOBBY EMILIO FELICIE LMHC

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 04/12/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 OXFORD AVE 10
BRONX NY
10463
US

IV. Provider business mailing address

3205 OXFORD AVE 10
THE BRONX NY
10463
US

V. Phone/Fax

Practice location:
  • Phone: 917-916-7692
  • Fax:
Mailing address:
  • Phone: 917-300-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number572462C
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2278S1500X
TaxonomySNF/Subacute Care Certified Respiratory Therapist
License Number4005478
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberS1901902
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number036483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: