MEDICARE: LISA MARY CORREALE MSW

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	1041C0700X	Clinical Social Worker	CW013686	PA

General Provider Information

NPI Number	:	1851462345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARY CORREALE MSW

Provider Business Mailing Address
First Line	:	264 AUDUBON AVE
Second Line	:
City	:	AUDUBON
State	:	NJ
Zip	:	08106-2312
Country	:	US
Telephone Number	:	215-631-7166
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S 2ND ST STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1612
Country	:	US
Telephone Number	:	215-631-7166
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	04/17/2026

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