Provider Demographics
NPI:1235309832
Name:CORREDOR, PRISCILLA (MSW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CORREDOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 EGRET AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6978
Mailing Address - Country:US
Mailing Address - Phone:772-216-5960
Mailing Address - Fax:
Practice Address - Street 1:1101 EGRET AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6978
Practice Address - Country:US
Practice Address - Phone:772-216-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health