Individual
DR. KEVIN MARK CORREIA
Active
Individual
DR. KEVIN MARK CORREIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
31520
TX
103TF0200X
Forensic Psychologist
31520
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0051GZ
BLUE CROSS/BLUE SHIELD
TX
05
—
1507170-01
—
TX
01
—
305188
CHAMPUS
TX
01
—
7473360
AETNA
TX
Enumeration date
08/30/2005
Last updated
04/25/2022
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