Provider Demographics
NPI:1912628850
Name:CORIDEO, ALEXA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:CORIDEO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-521-3448
Mailing Address - Fax:
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-696-4357
Practice Address - Fax:631-315-9473
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112742101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor