Correa-Illidge, Patricia S

Correa-Illidge, Patricia S is an individual health care provider with primary practice located at 4510 Frankford Ave 2Nd Floor, Philadelphia PA 19124-3602. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Correa-Illidge, Patricia S can be contacted via phone (215) 831-9882.

Contact Information

Primary practice address
4510 Frankford Ave 2Nd Floor Philadelphia PA 19124-3602
Phone: (215) 831-9882
Fax: (215) 831-9887
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X SW008617L Pennsylvania

Profile Details

NPI number 1598715179
LBN Legal business name Correa-Illidge, Patricia S
Credentials LSW
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Nov 1st, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598715179 NPPES
Pennsylvania Other 001663401 INDEPENDENCE BLUE CROSS
Pennsylvania Other 455792000 INDEPENDENCE BLUE CROSS

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