MEDICARE: DANIEL CORTORREAL LCAT, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	221700000X	Art Therapist	002219	NY

General Provider Information

NPI Number	:	1558959858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL CORTORREAL LCAT, ATR-BC

Provider Business Mailing Address
First Line	:	525 OCEAN PKWY APT 6G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5980
Country	:	US
Telephone Number	:	646-587-4771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1246 FULTON AVENUE 1ST FLOOR
Second Line	:	THE CHILD STUDY CENTER
City	:	BRONX
State	:	NY
Zip	:	10456
Country	:	US
Telephone Number	:	718-901-6888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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