Provider Demographics
NPI:1659196319
Name:LECORPS, MARIO (RN)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:LECORPS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11706 225TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1706
Mailing Address - Country:US
Mailing Address - Phone:718-712-8511
Mailing Address - Fax:718-527-5624
Practice Address - Street 1:11706 225TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1706
Practice Address - Country:US
Practice Address - Phone:718-712-8511
Practice Address - Fax:718-527-5624
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst