Healthcare Provider Details

I. General information

NPI: 1003283789
Provider Name (Legal Business Name): CHELSEA NICOLE CORBETT LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHELSEA NICOLE TYLER

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9958 N. MAIN STREET
BERLIN MD
21811-1077
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-973-2820
  • Fax: 410-973-2843
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: