MEDICARE: FANNY CORREA MSW

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	1041C0700X	Clinical Social Worker	ISW16332	FL

General Provider Information

NPI Number	:	1932871969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FANNY CORREA MSW

Provider Business Mailing Address
First Line	:	104 E LAMBRIGHT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-6143
Country	:	US
Telephone Number	:	206-226-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N REO ST STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1012
Country	:	US
Telephone Number	:	888-666-3089
Fax Number	:

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

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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