Provider Demographics
NPI:1467907733
Name:J.COREA MENTAL HEALTH COUNSELING PC
Entity Type:Organization
Organization Name:J.COREA MENTAL HEALTH COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COREA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC-T
Authorized Official - Phone:516-280-7285
Mailing Address - Street 1:585 STEWART AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4785
Mailing Address - Country:US
Mailing Address - Phone:516-351-7432
Mailing Address - Fax:516-280-7286
Practice Address - Street 1:585 STEWART AVE STE 700
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4785
Practice Address - Country:US
Practice Address - Phone:516-280-7285
Practice Address - Fax:516-280-7286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005894302F00000X
302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization