Provider Demographics
NPI:1366696825
Name:CORONA, GINA MARIE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:GINA MARIE
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3303
Mailing Address - Country:US
Mailing Address - Phone:315-243-6399
Mailing Address - Fax:
Practice Address - Street 1:5820 HERITAGE LANDING DR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9378
Practice Address - Country:US
Practice Address - Phone:315-701-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0565831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical