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General NPI Number Information
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NPI Number | 1922319086
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Entity Type | Organization
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Legal Business Name | CORRINA CENTER, LTD
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 303 E 83RD ST APT 23D
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City | NEW YORK
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State | NY
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Zip | 10028-4321
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Country | US
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Telephone | 212-945-6827
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E 83RD ST APT 23D
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City | NEW YORK
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State | NY
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Zip | 10028-4321
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Country | US
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Telephone | 212-945-6827
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. JACQUELINE POMO
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Credential | LCSW
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Telephone | 212-945-6827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73077019
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License Number State | NY
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