# PATRICIA S CORREA-ILLIDGE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1598715179
- **Gender:** F
- **Credential:** LSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | SW008617L | PA | Yes |

## Other

- **Enumeration date:** 05/12/2006
- **Last updated:** 11/01/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001663401 | INDEPENDENCE BLUE CROSS | PA |
| 01 | — | 455792000 | MAGELLAN MIS \# | PA |