Healthcare Provider Details

I. General information

NPI: 1487936472
Provider Name (Legal Business Name): DANIEL CORVIN MA, MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 TRANSFER RD
SAINT PAUL MN
55114-1418
US

IV. Provider business mailing address

1058 16TH AVE SE
MINNEAPOLIS MN
55414-2410
US

V. Phone/Fax

Practice location:
  • Phone: 651-728-0738
  • Fax: 651-645-7307
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: