Provider Demographics
NPI:1942244629
Name:VINCENZ, FELIX T (PHD)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:T
Last Name:VINCENZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TOWERBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4800
Mailing Address - Country:US
Mailing Address - Phone:573-808-4462
Mailing Address - Fax:314-877-5982
Practice Address - Street 1:29 TOWERBRIDGE PL
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-4800
Practice Address - Country:US
Practice Address - Phone:573-808-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493264824Medicaid
MO493264824Medicaid
MO220412808Medicare PIN
MO220415236Medicare PIN