=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154651792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FERDNAND FELICIANO M.A., LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 01/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9020 RANCHO DEL RIO DR STE. #136
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-5274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-848-0013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9020 RANCHO DEL RIO DR STE. #136
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-5274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-848-0013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH6348
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------