Doctor Name: | JESSE CYR CORBIN |
NPI Number: | 1134396641 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | LC11595 |
Business Practice Address: | 15 Mid Coast Dr Belfast, ME - 049156079 |
Business Phone Number: | 2073382295 |
Business Fax Number: | 2073382388 |
Mailing Address: | 78 Atlantic Pl, SOUTH PORTLAND |
State: | ME |
Postal Code: | 041062316 |
Phone Number: | 2078427736 |
Fax Number: | 2078427773 |
NPI Enumeration Date: | 05/14/2008 |
NPI Last Update Date: | 02/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC11595 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |