Provider Demographics
NPI:1558959858
Name:CORTORREAL, DANIEL (LCAT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CORTORREAL
Suffix:
Gender:M
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OCEAN PKWY APT 6G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5980
Mailing Address - Country:US
Mailing Address - Phone:646-587-4771
Mailing Address - Fax:
Practice Address - Street 1:1246 FULTON AVENUE 1ST FLOOR
Practice Address - Street 2:THE CHILD STUDY CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-901-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002219221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist