Healthcare Provider Details

I. General information

NPI: 1467907733
Provider Name (Legal Business Name): J.COREA MENTAL HEALTH COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STEWART AVE STE 700
GARDEN CITY NY
11530-4785
US

IV. Provider business mailing address

585 STEWART AVE STE 700
GARDEN CITY NY
11530-4785
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-7285
  • Fax: 516-280-7286
Mailing address:
  • Phone: 516-351-7432
  • Fax: 516-280-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number005894
License Number StateNY

VIII. Authorized Official

Name: JESSIA COREA
Title or Position: CEO, MENTAL HEALTH COUNSELOR
Credential: LMHC, CASAC-T
Phone: 516-280-7285