Provider Demographics
NPI:1386076537
Name:CORNAGO, GEORGINA
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:CORNAGO
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 1:246 PEARL ST
Mailing Address - Street 2:APT. B
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1252
Mailing Address - Country:US
Mailing Address - Phone:516-404-1123
Mailing Address - Fax:
Practice Address - Street 1:246 PEARL ST
Practice Address - Street 2:APT. B
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1252
Practice Address - Country:US
Practice Address - Phone:516-404-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst