Provider Demographics
NPI:1558862516
Name:CORPUZ, SARINA MARIE
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:MARIE
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARINA
Other - Middle Name:MARIE
Other - Last Name:CORPUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SSBT
Mailing Address - Street 1:415 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513
Mailing Address - Country:US
Mailing Address - Phone:360-359-8986
Mailing Address - Fax:
Practice Address - Street 1:3443 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3091
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABACB421878103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst