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NPI Code Detail

MEDICARE: DR. ANNA ELIZABETH FELICIANO PSY.D.

MEDICARE: DR. ANNA ELIZABETH FELICIANO PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1241SC

General Provider Information

NPI Number : 1366984932
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNA ELIZABETH FELICIANO PSY.D.
Provider Business Mailing Address
First Line : 2625 RUTLEDGE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2520
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2625 RUTLEDGE ST
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2520
Country : US
Telephone Number : 803-799-0144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2016
Last Update Date : 11/13/2016

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