Healthcare Provider Details

I. General information

NPI: 1821935123
Provider Name (Legal Business Name): ELIZABETH ANN CORTORREAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BERKSHIRE BLVD
WYOMISSING PA
19610-1246
US

IV. Provider business mailing address

875 BERKSHIRE BLVD
WYOMISSING PA
19610-1246
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax:
Mailing address:
  • Phone: 844-244-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: