Provider Demographics
NPI:1407384399
Name:CORREA MONTERO, YISEL
Entity type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:CORREA MONTERO
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 1:2500 E HALLANDALE BEACH BLVD STE 802
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4841
Mailing Address - Country:US
Mailing Address - Phone:863-220-8627
Mailing Address - Fax:954-272-7854
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 802
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4841
Practice Address - Country:US
Practice Address - Phone:863-220-8627
Practice Address - Fax:954-272-7854
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician