Doctor Name: | ROY STEPHAN CORSON |
NPI Number: | 1689065815 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED., L.P.C., N.C.C |
License Number: | 37PC00511900 |
Business Practice Address: | 36 Midvale Rd Lower Level L-5 Mountain Lakes, NJ - 070461353 |
Business Phone Number: | 8623771096 |
Business Fax Number: | |
Mailing Address: | 36 Midvale Rd, Lower Level L-5 MOUNTAIN LAKES |
State: | NJ |
Postal Code: | 070461353 |
Phone Number: | 8623771096 |
Fax Number: | |
NPI Enumeration Date: | 02/10/2015 |
NPI Last Update Date: | 02/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 37PC00511900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |