Individual
CORISSA GIDULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
848 BUCCANEER LN, MANAHAWKIN, NJ 08050-2112
(484) 258-6050
Mailing address
848 BUCCANEER LN, MANAHAWKIN, NJ 08050-2112
(484) 258-6050
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC004512
GA
103K00000X
Behavior Analyst
1-22-59762
NJ
Other
Enumeration date
01/25/2016
Last updated
02/28/2023
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