Organization Name: | ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC |
NPI Number: | 1073611166 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VICKI BRAULT (BUSINESS MANAGER) |
Mailing Address: | 8587 S. Mason Montgomery Rd. Suite 9 Mason |
State: | OH US |
Postal Code: | 450409317 |
Phone Number: | 5139196722 |
Fax Number: | 5132820876 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 02/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 5748 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |