Provider Demographics
NPI:1891862348
Name:CORREA WALKER, RODRIGO (LPSY, LMHC)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:CORREA WALKER
Suffix:
Gender:M
Credentials:LPSY, LMHC
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPSY, LMHC
Mailing Address - Street 1:1546 MADISON AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4553
Mailing Address - Country:US
Mailing Address - Phone:347-681-8628
Mailing Address - Fax:
Practice Address - Street 1:1546 MADISON AVE APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4553
Practice Address - Country:US
Practice Address - Phone:347-681-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC4070101YM0800X
NY003580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07782007Medicaid