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General NPI Number Information
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NPI Number | 1417455627
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Entity Type | Individual
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Provider Name | LYNETTE COREANO
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1887 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5530
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Country | US
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Telephone | 772-463-0444
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Fax | 772-219-1339
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Provider Business Mailing Address
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Address Line | 1045 FESTIVO LN NE
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City | PALM BAY
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State | FL
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Zip | 32907-5569
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Country | US
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Telephone | 321-514-8284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-63075
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License Number State |
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