Provider Demographics
NPI:1811144777
Name:CORTES, EMILIO G (PSYD,)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:G
Last Name:CORTES
Suffix:
Gender:M
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 POTTERS RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4324
Mailing Address - Country:US
Mailing Address - Phone:757-498-9391
Mailing Address - Fax:757-498-7073
Practice Address - Street 1:2580 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4324
Practice Address - Country:US
Practice Address - Phone:757-498-9391
Practice Address - Fax:757-498-7073
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004564103TC0700X
PR3090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical