Provider Demographics
NPI:1063990646
Name:KOROPOULOS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOROPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3531
Mailing Address - Country:US
Mailing Address - Phone:072-758-9394
Mailing Address - Fax:407-282-3674
Practice Address - Street 1:1002 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3531
Practice Address - Country:US
Practice Address - Phone:072-758-9394
Practice Address - Fax:407-282-3674
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YA0400XMedicaid