Provider Demographics
NPI:1427615830
Name:PINTO CORRO, ANDREA ALEXANDRA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALEXANDRA
Last Name:PINTO CORRO
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 1:350 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1248
Mailing Address - Country:US
Mailing Address - Phone:786-908-7718
Mailing Address - Fax:
Practice Address - Street 1:350 E 58TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1248
Practice Address - Country:US
Practice Address - Phone:786-908-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-11884106E00000X
FL18-47163103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst