Provider Demographics
NPI:1659798304
Name:DEMALA, COREY (LMHC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DEMALA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2205
Mailing Address - Country:US
Mailing Address - Phone:845-224-6258
Mailing Address - Fax:845-258-2700
Practice Address - Street 1:44 AMITY RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2205
Practice Address - Country:US
Practice Address - Phone:845-224-6258
Practice Address - Fax:845-258-2700
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health