Provider Demographics
NPI:1821162363
Name:CORSELLO, LILY JOANN (DMIN)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:JOANN
Last Name:CORSELLO
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27332 DOMINICA LN
Mailing Address - Street 2:
Mailing Address - City:RAMROD KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-5453
Mailing Address - Country:US
Mailing Address - Phone:954-822-8874
Mailing Address - Fax:305-741-7971
Practice Address - Street 1:100 COUNTY RD
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-4823
Practice Address - Country:US
Practice Address - Phone:954-822-8874
Practice Address - Fax:305-741-7971
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4676101YM0800X
TX13064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional