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PATRICIA S CORREA-ILLIDGE LSW NPI 1598715179


NPI Information

NPI: 1598715179
Provider Name: PATRICIA S CORREA-ILLIDGE, LSW
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

PECOS Registration: Yes

Address:
4510 FRANKFORD AVE
2ND FLOOR
PHILADELPHIA, PA
ZIP 19124
Phone: (215) 831-9882
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Patricia S Correa-illidge, LSW is a mental health counselor in Philadelphia, PA. Patricia S Correa-illidge, LSW NPI is 1598715179. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4510 FRANKFORD AVE
2ND FLOOR
PHILADELPHIA, PA
ZIP 19124-602
Phone: (215) 831-9882
Fax: (215) 831-9887

The NPI 1598715179 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 5/12/2006 and was last updated on 11/1/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YM0800XCounselorMental HealthSW008617LPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1455792000OTHERPENNSYLVANIAMAGELLAN MIS #
2001663401OTHERPENNSYLVANIAINDEPENDENCE BLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.