Most Relevant Information
Provider Data
| NPI Number: | 1003665829 |
| Provider Name: | WILFREDO MALE CORREA CRPA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | CRPA-5781 |
Most Important Dates
| Enumeration Date: | 05/14/2024 |
| Last Updated: | 05/14/2024 |
Provider Practice Location
770 GRAND BLVD STE 17
DEER PARK
NY
117295725
Practice Location Phone/Fax
| Phone: | 6313924357 |
| Fax: |
Provider Mailing Location
220 FAIRVIEW CIR
MIDDLE ISLAND
NY
119532353
Provider Mailing Phone/Fax
| Phone: | 3475843565 |
| Fax: |