MEDICARE: CORBETT LOGAN LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	17880	MD

General Provider Information

NPI Number	:	1386981421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORBETT LOGAN LCSW-C

Provider Business Mailing Address
First Line	:	9616 EAVES DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5918
Country	:	US
Telephone Number	:	443-744-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	10711 RED RUN BLVD STE 101
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5138
Country	:	US
Telephone Number	:	443-744-9463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	08/11/2025

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