Provider Demographics
NPI:1013788553
Name:CORRAL-OZAETA, DEBANY (LMSW)
Entity type:Individual
Prefix:
First Name:DEBANY
Middle Name:
Last Name:CORRAL-OZAETA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JUMPER LN
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6002
Mailing Address - Country:US
Mailing Address - Phone:505-503-5243
Mailing Address - Fax:
Practice Address - Street 1:110 JUMPER LN
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6002
Practice Address - Country:US
Practice Address - Phone:505-503-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM11034104100000X
TN15081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker