Provider Demographics
NPI:1942384573
Name:FELVER, COLLEEN K (LCSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:K
Last Name:FELVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6996 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078
Mailing Address - Country:US
Mailing Address - Phone:315-254-4804
Mailing Address - Fax:315-218-5622
Practice Address - Street 1:112 DEWITT ST
Practice Address - Street 2:STE 204
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-254-4804
Practice Address - Fax:315-218-5266
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28339Medicare UPIN
IA0623Medicare ID - Type Unspecified