Provider Demographics
NPI:1033308788
Name:CORREA, LISA IANNELLI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:IANNELLI
Last Name:CORREA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13039 W LINEBAUGH AVE
Mailing Address - Street 2:BUILDING V, SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4451
Mailing Address - Country:US
Mailing Address - Phone:888-531-1313
Mailing Address - Fax:888-551-6035
Practice Address - Street 1:13039 W LINEBAUGH AVE
Practice Address - Street 2:BUILDING V, SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4451
Practice Address - Country:US
Practice Address - Phone:888-531-1313
Practice Address - Fax:888-551-6035
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7601103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH635Medicare PIN