# CHARLES CORBALLY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063921740
- **Authorized official:** MR. CHARLES J. CORBALLY LCSW (SOLE OWNER)
- **Authorized official phone:** (802) 281-3330

## Contact information

- **Practice address:** 2 CHURCH ST STE 3G, BURLINGTON, VT 05401-4457
- **Practice address phone:** (802) 281-3330
- **Practice address fax:** (802) 540-8199
- **Mailing address:** 2 CHURCH ST STE 3G, BURLINGTON, VT 05401-4457
- **Mailing address phone:** (802) 281-3330

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 089.0117025 | VT | Yes |

## Other

- **Enumeration date:** 09/25/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1028428 | — | VT |