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General NPI Number Information
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NPI Number | 1700314473
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Entity Type | Individual
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Provider Name | ANDREA LYNNE CORSON LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 2800 BRUCKNER BLVD
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City | BRONX
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State | NY
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Zip | 10465-1369
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Country | US
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Telephone | 914-222-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DIPLOMAT DR APT 2O
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City | MOUNT KISCO
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State | NY
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Zip | 10549-2005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 057300-1
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License Number State | NY
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