Provider Demographics
NPI:1972474666
Name:CORREA, FLAVIO ALEJANDRO
Entity type:Individual
Prefix:
First Name:FLAVIO
Middle Name:ALEJANDRO
Last Name:CORREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4463 W HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1428
Mailing Address - Country:US
Mailing Address - Phone:813-475-8985
Mailing Address - Fax:
Practice Address - Street 1:4463 W HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1428
Practice Address - Country:US
Practice Address - Phone:813-475-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician