Provider Demographics
NPI:1487093050
Name:ALICIA FELLER LCSW LLC
Entity type:Organization
Organization Name:ALICIA FELLER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-581-3019
Mailing Address - Street 1:11 KINDLE LN
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2118
Mailing Address - Country:US
Mailing Address - Phone:203-581-3019
Mailing Address - Fax:
Practice Address - Street 1:1057 BROAD ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4219
Practice Address - Country:US
Practice Address - Phone:203-581-3019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty