Active NPI
Jacquelyn Ravenden Feliciano
- Dance Therapist
- New York, NY
National Provider Identifier
1811510696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dance Therapist
- License
- 002612
- Practice address
- 32 Union SQ E
New York, NY 10003-3209 - Phone
- (212) 678-0252
- NPI assigned
- May 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dance Therapist | 225600000X | 002612 | NY | Primary |
Addresses
Primary practice location
32 Union SQ E
New York, NY 10003-3209
Mailing address
110 Saint James PL Apt 1
Brooklyn, NY 11238-1813
Phone (443) 797-4057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002612 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637539200000",
"number": "1811510696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 SAINT JAMES PL APT 1",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112381813",
"telephone_number": "443-797-4057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 UNION SQ E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100033209",
"telephone_number": "212-678-0252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FELICIANO",
"first_name": "JACQUELYN",
"middle_name": "RAVENDEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-27",
"last_updated": "2021-11-22",
"certification_date": "2021-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225600000X",
"taxonomy_group": "",
"desc": "Dance Therapist",
"state": "NY",
"license": "002612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.