Provider Demographics
NPI:1659557965
Name:CORENA, JOSE E (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:CORENA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 VENTURA BLVD STE 1204
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2269
Mailing Address - Country:US
Mailing Address - Phone:818-336-6441
Mailing Address - Fax:818-336-6441
Practice Address - Street 1:15233 VENTURA BLVD STE 1204
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2269
Practice Address - Country:US
Practice Address - Phone:818-336-6441
Practice Address - Fax:818-336-6441
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical