Healthcare Provider Details

I. General information

NPI: 1558959858
Provider Name (Legal Business Name): DANIEL CORTORREAL LCAT, ATR-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 FULTON AVENUE 1ST FLOOR THE CHILD STUDY CENTER
BRONX NY
10456
US

IV. Provider business mailing address

525 OCEAN PKWY APT 6G
BROOKLYN NY
11218-5980
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-6888
  • Fax:
Mailing address:
  • Phone: 646-587-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: