Provider Demographics
NPI:1740076470
Name:CORREALE, JESSICA (LCPC-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CORREALE
Suffix:
Gender:
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 IMPATIENS MEWS
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7339
Mailing Address - Country:US
Mailing Address - Phone:207-745-2383
Mailing Address - Fax:207-745-2383
Practice Address - Street 1:3333 S CONGRESS AVE STE 400
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7346
Practice Address - Country:US
Practice Address - Phone:561-623-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health