Healthcare Provider Details

I. General information

NPI: 1851526867
Provider Name (Legal Business Name): KARLA CORRIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CENTRAL AVE
BRIDGEPORT CT
06610-2717
US

IV. Provider business mailing address

1635 CENTRAL AVE
BRIDGEPORT CT
06610-2717
US

V. Phone/Fax

Practice location:
  • Phone: 203-551-7640
  • Fax:
Mailing address:
  • Phone: 203-551-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3382
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: