Healthcare Provider Details

I. General information

NPI: 1275455461
Provider Name (Legal Business Name): MANUEL ALEJANDRO CORREA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 3RD ST STE A
SAN RAFAEL CA
94901-3580
US

IV. Provider business mailing address

1050 CASTRO ST
SAN LEANDRO CA
94577-3443
US

V. Phone/Fax

Practice location:
  • Phone: 415-515-0359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: