Provider Demographics
NPI:1316820459
Name:CORREA VARGAS, JOSEPH ANDRES
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDRES
Last Name:CORREA VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ROAD RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:PAISLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32767-9459
Mailing Address - Country:US
Mailing Address - Phone:352-321-0220
Mailing Address - Fax:
Practice Address - Street 1:6909 OLD HIGHWAY 441 S STE 119
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7039
Practice Address - Country:US
Practice Address - Phone:352-358-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1327717106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician