Provider Demographics
NPI:1245520220
Name:CORREIA-DEPAOLA, EILEEN (LMT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CORREIA-DEPAOLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:CORREIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:35 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1818
Mailing Address - Country:US
Mailing Address - Phone:860-919-4904
Mailing Address - Fax:
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:860-919-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006424225700000X
CT9995656376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide