Provider Demographics
NPI:1982870168
Name:CORREA, MYLADIS (CASAC-T)
Entity Type:Individual
Prefix:
First Name:MYLADIS
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MAIDEN LN FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4712
Mailing Address - Country:US
Mailing Address - Phone:212-571-1180
Mailing Address - Fax:
Practice Address - Street 1:90 MAIDEN LN FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4712
Practice Address - Country:US
Practice Address - Phone:212-571-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor