1073876256 NPI number — MS. PATRICIA J CORBETT LICSW

Table of content: MS. PATRICIA J CORBETT LICSW (NPI 1073876256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073876256 NPI number — MS. PATRICIA J CORBETT LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORBETT
Provider First Name:
PATRICIA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073876256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOONSOCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02895-0856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-235-7000
Provider Business Mailing Address Fax Number:
401-767-4516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 CUMBERLAND ST # 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-235-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  ISW01232 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".