MEDICARE: CORINNE MILENTIJEVIC MSSA/LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	I.0010155	OH
2	1041C0700X	Clinical Social Worker	S-0021574	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568440048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE MILENTIJEVIC MSSA/LISW

Provider Business Mailing Address
First Line	:	8577 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-2345
Country	:	US
Telephone Number	:	330-856-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	8170 SOUTH AVENUE
Second Line	:	SUITE 7
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6434
Country	:	US
Telephone Number	:	330-953-3325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	06/11/2026

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