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General NPI Number Information
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NPI Number | 1053562744
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Entity Type | Organization
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Legal Business Name | SUSAN CORBETT INC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 4067A S TAMIAMI TRL
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City | SARASOTA
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State | FL
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Zip | 34231-3623
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Country | US
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Telephone | 941-926-8080
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Fax | 888-664-2547
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Provider Business Mailing Address
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Address Line | 2247 GOLDENROD ST
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City | SARASOTA
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State | FL
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Zip | 34239-5318
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Country | US
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Telephone | 941-926-8080
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Fax | 888-664-2547
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. SUSAN CORBETT
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Credential | LCSW, BCD
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Telephone | 941-926-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWL141
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License Number State | FL
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