1073611166 NPI number — ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC

Table of content: (NPI 1073611166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073611166 NPI number — ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1073611166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8587 S. MASON MONTGOMERY RD.
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-9317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-919-6722
Provider Business Mailing Address Fax Number:
513-282-0876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8587 S. MASON MONTGOMERY RD.
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-9317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-919-6722
Provider Business Practice Location Address Fax Number:
513-282-0876
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAULT
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
513-919-6722

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  5748 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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