Healthcare Provider Details

I. General information

NPI: 1124519053
Provider Name (Legal Business Name): CORINA A MANDERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 HALSTEAD AVE UNIT 164
HARRISON NY
10528-7513
US

IV. Provider business mailing address

258 HALSTEAD AVE UNIT 164
HARRISON NY
10528-7513
US

V. Phone/Fax

Practice location:
  • Phone: 929-548-4785
  • Fax:
Mailing address:
  • Phone: 929-548-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091605
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: