Individual
BLAISE CORSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 DRAKE AVE, STATEN ISLAND, NY 10314-3012
(718) 619-1206
Mailing address
118 DRAKE AVE, STATEN ISLAND, NY 10314-3012
(718) 619-1206
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0965271
NY
Other
Enumeration date
03/11/2016
Last updated
03/11/2016
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