Provider Demographics
NPI:1174093488
Name:FELICIE, BOBBY E (MRFELICIE)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:E
Last Name:FELICIE
Suffix:
Gender:M
Credentials:MRFELICIE
Other - Prefix:MR
Other - First Name:BOBBY
Other - Middle Name:EMILIO
Other - Last Name:FELICIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:3205 OXFORD AVE
Mailing Address - Street 2:10
Mailing Address - City:THE BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:917-300-8523
Mailing Address - Fax:
Practice Address - Street 1:3205 OXFORD AVE
Practice Address - Street 2:10
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:917-916-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC572462C2083P0901X
NY40054782278S1500X
VAS1901902103TP2701X
FL036483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No2278S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedSNF/Subacute CareGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3057202OtherWORKERS COMPENSATION BOARD
NY201921906550732320Medicaid
NY4005478OtherBEHAVIORAL HEALTH MENTAL THERAPY
NYNYSOMIG-2019110Medicaid
VAS1901902OtherPSYCHOTHERAPY