Wilfredo Male Correa, CRPA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CRPA-5781 Issued in NY

Practice address

770 Grand Blvd Ste 17
Deer Park, NY 11729-5725

Phone

(631) 392-4357

NPI assigned

May 14, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Enhancement & Substance Abuse Medicine Treatment PLLC

  • Community/Behavioral Health Agency
  • Deer Park, NY
  • NPI 1346680071
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1003665829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 FAIRVIEW CIR",
            "city": "MIDDLE ISLAND",
            "state": "NY",
            "postal_code": "119532353",
            "telephone_number": "347-584-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 GRAND BLVD STE 17",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295725",
            "telephone_number": "631-392-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORREA",
        "first_name": "WILFREDO",
        "middle_name": "MALE",
        "credential": "CRPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "CRPA-5781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Surgical Supply of Toms River, Inc
• Comprehensive Medical PC
• Conscious Mind Psychotherapy
• Gabriella Coraci, MS CF-SLP, TSSLD
• Ardouin Coriolan
• Elizabeth Ann Cort-Ranghel, PCA
• Corvitals, Inc.
• Nicholas Costa, LMSW
• James Cotrone
• John Coughlin

• All providers in Deer Park, NY
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.