Provider Demographics
NPI:1336932441
Name:FELICIANO, MARILYN (LAC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 PARK AVE # A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5565
Mailing Address - Country:US
Mailing Address - Phone:908-279-6705
Mailing Address - Fax:
Practice Address - Street 1:1550 PARK AVE # A
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5565
Practice Address - Country:US
Practice Address - Phone:908-279-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374C00866200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health