Provider Demographics
NPI:1235777319
Name:CORNELIO, KARINA ESTHER (MSW, CASAC-T)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:ESTHER
Last Name:CORNELIO
Suffix:
Gender:F
Credentials:MSW, CASAC-T
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:E
Other - Last Name:CORNELIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CASAC-T
Mailing Address - Street 1:1727 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4611
Mailing Address - Country:US
Mailing Address - Phone:646-340-1403
Mailing Address - Fax:212-694-4619
Practice Address - Street 1:1727 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4611
Practice Address - Country:US
Practice Address - Phone:646-340-1403
Practice Address - Fax:212-694-4619
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31468101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY778848873OtherNEW YORK STATE IDENTIFICATION