Provider Demographics
NPI:1871795112
Name:CORCOLL-IGLESIAS, YAMEL A (MA,LMFT)
Entity type:Individual
Prefix:MRS
First Name:YAMEL
Middle Name:A
Last Name:CORCOLL-IGLESIAS
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BANK ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3006
Mailing Address - Country:US
Mailing Address - Phone:203-667-1812
Mailing Address - Fax:
Practice Address - Street 1:1 BANK ST
Practice Address - Street 2:SUITE #207
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3006
Practice Address - Country:US
Practice Address - Phone:203-667-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist