Organization
CHARLES CORBALLY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J. CORBALLY LCSW (SOLE OWNER)
(802) 281-3330
Entity
Organization
Contact information
Practice address
2 CHURCH ST STE 3G, BURLINGTON, VT 05401-4457
(802) 281-3330
(802) 540-8199
Mailing address
2 CHURCH ST STE 3G, BURLINGTON, VT 05401-4457
(802) 281-3330
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0117025
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028428
—
VT
Enumeration date
09/25/2017
Last updated
07/21/2022
Update your record
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