Provider Demographics
NPI:1871964189
Name:CORREIA, DEBRA (MSP)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:
Last Name:CORREIA
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2368
Mailing Address - Country:US
Mailing Address - Phone:603-312-6294
Mailing Address - Fax:
Practice Address - Street 1:50 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3672
Practice Address - Country:US
Practice Address - Phone:603-516-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist