Healthcare Provider Details

I. General information

NPI: 1356634810
Provider Name (Legal Business Name): JOSEPH DANTE CORSO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD
SALINE MI
48176-9773
US

IV. Provider business mailing address

8303 PLATT RD
SALINE MI
48176-9773
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4383
  • Fax: 734-429-4561
Mailing address:
  • Phone: 734-295-4383
  • Fax: 734-429-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number6801061431
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: