Provider Demographics
NPI:1134895964
Name:CORONA, ARY LACY
Entity type:Individual
Prefix:MRS
First Name:ARY
Middle Name:LACY
Last Name:CORONA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ARY
Other - Middle Name:NOVONTY
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2514 N WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1462
Mailing Address - Country:US
Mailing Address - Phone:559-554-9703
Mailing Address - Fax:
Practice Address - Street 1:2514 N WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1462
Practice Address - Country:US
Practice Address - Phone:559-554-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
CA46118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist