Provider Demographics
NPI:1235476771
Name:CORREA, RAFAEL IVAN (MA)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:IVAN
Last Name:CORREA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 HARBOR BEND CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8619
Mailing Address - Country:US
Mailing Address - Phone:407-761-7543
Mailing Address - Fax:
Practice Address - Street 1:7909 HARBOR BEND CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8619
Practice Address - Country:US
Practice Address - Phone:407-761-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health