MEDICARE: MR. FELIX E. DEJESUS LCSW

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
1	1041C0700X	Clinical Social Worker	44SC01368200	NJ

General Provider Information

NPI Number	:	1528167921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FELIX E. DEJESUS LCSW

Provider Business Mailing Address
First Line	:	U.S. ARMY FAMILY AND MWR
Second Line	:	BLDG # 2494 RICKER ROAD, FORT BLISS
City	:	EL PASO
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-569-7758
Fax Number	:	915-568-4357

Provider Business Practice Location Address
First Line	:	U.S. ARMY FAMILY AND MWR
Second Line	:	BLDG # 2494 RICKER ROAD, FORT BLISS
City	:	EL PASO
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-569-7758
Fax Number	:	915-568-4357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/17/2018

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