Healthcare Provider Details

I. General information

NPI: 1790691566
Provider Name (Legal Business Name): DANIEL OMAR CORNIDE LMHC, CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 SW 25TH AVE APT A
BOYNTON BEACH FL
33426-7482
US

IV. Provider business mailing address

1426 SW 25TH AVE APT A
BOYNTON BEACH FL
33426-7482
US

V. Phone/Fax

Practice location:
  • Phone: 954-529-3922
  • Fax:
Mailing address:
  • Phone: 954-529-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: