Provider Demographics
NPI:1063018778
Name:CORELLA, DAVID M (LICSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:CORELLA
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:M
Other - Last Name:CALLAHAN
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:LSWAIC
Mailing Address - Street 1:7415 5TH AVE NE APT 211
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5370
Mailing Address - Country:US
Mailing Address - Phone:480-226-6962
Mailing Address - Fax:
Practice Address - Street 1:4200 STONE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7431
Practice Address - Country:US
Practice Address - Phone:206-461-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker