Provider Demographics
NPI:1447024377
Name:CORRALES, MARISA LYNN
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LYNN
Last Name:CORRALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 NW 74TH CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3351
Mailing Address - Country:US
Mailing Address - Phone:954-446-3905
Mailing Address - Fax:
Practice Address - Street 1:9000 BURMA RD STE 109
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1606
Practice Address - Country:US
Practice Address - Phone:561-508-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician