Organization
THERAPY IS SELF DISCOVERY LISCENSED CLINICALSOCIAL WORKER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH FRANCIS CORBIN LCSW-R (OWNER)
(631) 766-1240
Entity
Organization
Contact information
Practice address
183 S WELLWOOD AVE UNIT A, LINDENHURST, NY 11757-4935
(631) 766-1240
(631) 991-3391
Mailing address
183 S WELLWOOD AVE UNIT A, LINDENHURST, NY 11757-4935
(631) 766-1240
(631) 991-3391
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457869208
MEDICARE NPI
NY
Enumeration date
10/31/2019
Last updated
10/31/2019
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