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Individual

CHARLES JOSEPH CORBALLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LICSW

Contact information

Practice address
2 CHURCH ST, SUITE 3G, BURLINGTON, VT 05401-4299
(802) 281-3330
Mailing address
2 CHURCH STREET, SUITE 3G, BURLINGTON, VT 05401
(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
08/31/2016
Last updated
04/17/2017
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