Provider Demographics
NPI:1164975355
Name:CORUJO FEIJOO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CORUJO FEIJOO
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 1:2645 EXECUTIVE PARK DR # 534
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3624
Mailing Address - Country:US
Mailing Address - Phone:954-512-4827
Mailing Address - Fax:954-289-9603
Practice Address - Street 1:2645 EXECUTIVE PARK DR # 534
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3624
Practice Address - Country:US
Practice Address - Phone:954-512-4827
Practice Address - Fax:954-289-9603
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-22230103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst