Healthcare Provider Details

I. General information

NPI: 1235782467
Provider Name (Legal Business Name): CORBIN F GERARD CAADE, BT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 EASY AVE
LONG BEACH CA
90810-2848
US

IV. Provider business mailing address

2931 EASY AVE
LONG BEACH CA
90810-2848
US

V. Phone/Fax

Practice location:
  • Phone: 310-751-0091
  • Fax:
Mailing address:
  • Phone: 310-751-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13078-R
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: