Corrine Lynn Materese, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW14632 Issued in FL

Practice address

939 Tully St
Hurlburt Field, FL 32544-5751

Phone

(850) 884-8686

NPI assigned

Oct 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Corrine Lynn Fabozzi Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: corrinematerese@tdh.allscriptsdirect.net

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.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1174034136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 23RD ST",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325782921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 TULLY ST",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445751",
            "telephone_number": "850-884-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATERESE",
        "first_name": "CORRINE",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW14632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORRINE",
            "last_name": "FABOZZI",
            "middle_name": "LYNN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Mariscal, LCSW, MPH
• Marc Marrero, IDMT
• Justin R Martin, MD
• Sheridan Ann Martin, O.D.
• Jennifer June Sillence Masino, PSY. D.
• Anisa Lee Mathis, PA-C
• Derick Mayberry, DDS
• Tracy Elizabeth Mayfield, PSYD
• Shardale McAfee
• Velvet L. McAlister, IDMT

• Clinical Social Worker in Hurlburt Field, FL
• Providers in Hurlburt Field, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.