Corissa Gidula, MA, BCBA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

APC004512 Issued in GA

Practice address

848 Buccaneer LN
Manahawkin, NJ 08050-2112

Phone

(484) 258-6050

NPI assigned

Jan 25, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1821455692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 BUCCANEER LN",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502112",
            "telephone_number": "484-258-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 BUCCANEER LN",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502112",
            "telephone_number": "484-258-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIDULA",
        "first_name": "CORISSA",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-25",
        "last_updated": "2023-02-28",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1-22-59762",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "APC004512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Gerhard, RD
• Karen Gesicki, LCSW
• Alexandra Giancola, OTR/L
• Brianna Gibaldi, LCSW
• Don Eugene Gibbons, PH.D.
• Neelam Gail Gidwaney, M.D.
• Kelley Ann Gilger, BSN, CNM
• Kathleen Nora Gill, RN, HTP
• Joseph Robert Ginelli, LSW, LCADC, CCS
• William B Glenn, D.O.

• Mental Health Counselor in Manahawkin, NJ
• Providers in Manahawkin, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.