Healthcare Provider Details

I. General information

NPI: 1336192517
Provider Name (Legal Business Name): PAMELA K. CORBIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8587 S MASON MONTGOMERY RD SUITE 9
MASON OH
45040-9233
US

IV. Provider business mailing address

8587 S MASON MONTGOMERY RD SUITE 9
MASON OH
45040-9233
US

V. Phone/Fax

Practice location:
  • Phone: 513-919-6722
  • Fax: 513-282-0876
Mailing address:
  • Phone: 513-919-6722
  • Fax: 513-282-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5748
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: