Provider Demographics
NPI:1245577261
Name:MARTINEZ-CORREA, JOSELENE (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSELENE
Middle Name:
Last Name:MARTINEZ-CORREA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 BRUCE B DOWNS BLVD # 325
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9262
Mailing Address - Country:US
Mailing Address - Phone:973-289-3500
Mailing Address - Fax:
Practice Address - Street 1:442 W KENNEDY BLVD STE 280
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1464
Practice Address - Country:US
Practice Address - Phone:813-467-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004667103TC0700X
FLPY10834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113195600Medicaid