MEDICARE: ADELAIDE CORVELLE

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	104100000X	Social Worker	R014050	NY

General Provider Information

NPI Number	:	1871618223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELAIDE CORVELLE

Provider Business Mailing Address
First Line	:	78 LAKEVIEW DR
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-2316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 4TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7908
Country	:	US
Telephone Number	:	631-665-6707
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ ADELAIDE CORVELLE ” Practice Location

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