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NPI Code Detail

MEDICARE: EVELYN RAE CORBIN LMSW

MEDICARE: EVELYN RAE CORBIN LMSW
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
11041C0700XClinical Social Worker6801109744MI
2104100000XSocial Worker6801109744MI

General Provider Information

NPI Number : 1447816665
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN RAE CORBIN LMSW
Provider Business Mailing Address
First Line : 17 W 2ND ST
Second Line :
City : MILAN
State : MI
Zip : 48160-1007
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 108 N LAFAYETTE ST STE D
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-1883
Country : US
Telephone Number : 616-200-4030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2019
Last Update Date : 03/13/2025

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