Healthcare Provider Details

I. General information

NPI: 1134412828
Provider Name (Legal Business Name): MARY C. CORIANO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 GOODLETTE RD N
NAPLES FL
34102-5656
US

IV. Provider business mailing address

2155 MORNING SUN LN
NAPLES FL
34119-3329
US

V. Phone/Fax

Practice location:
  • Phone: 239-430-2303
  • Fax: 239-430-2304
Mailing address:
  • Phone: 239-272-7189
  • Fax: 239-431-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9823
License Number StateFL

VIII. Authorized Official

Name: MRS. MARY C. CORIANO
Title or Position: PRESIDENT
Credential: LSCW
Phone: 239-272-7189