Provider Demographics
NPI:1801016324
Name:CORREDOR, JEANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:CORREDOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6442 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6442 COMMERCE PARK DR
Practice Address - Street 2:SUITE #1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4723
Practice Address - Country:US
Practice Address - Phone:239-768-6500
Practice Address - Fax:239-768-6421
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7717103TC1900X
NY016181-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling