MEDICARE: ROGER L. CORBIN LCSW

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	SW19198	FL
2	1041C0700X	Clinical Social Worker	SW126527	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891359402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER L. CORBIN LCSW

Provider Business Mailing Address
First Line	:	900 N SWALLOW TAIL DR STE 105
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6103
Country	:	US
Telephone Number	:	386-333-9717
Fax Number	:	386-333-9718

Provider Business Practice Location Address
First Line	:	900 N SWALLOW TAIL DR STE 105
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6103
Country	:	US
Telephone Number	:	386-333-9717
Fax Number	:

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	01/23/2026

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Directions to “ ROGER L. CORBIN LCSW” Practice Location

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