Provider Demographics
NPI:1003961160
Name:CORONEL, NEREIDA I
Entity Type:Individual
Prefix:MS
First Name:NEREIDA
Middle Name:I
Last Name:CORONEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4206
Mailing Address - Country:US
Mailing Address - Phone:718-710-7834
Mailing Address - Fax:
Practice Address - Street 1:2009 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3208
Practice Address - Country:US
Practice Address - Phone:212-348-4660
Practice Address - Fax:212-348-5427
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor