Provider Demographics
NPI:1033570486
Name:CORSON, WARREN IV
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:
Last Name:CORSON
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 WOLCOTT ST
Mailing Address - Street 2:39
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6469
Mailing Address - Country:US
Mailing Address - Phone:860-543-2384
Mailing Address - Fax:
Practice Address - Street 1:489 WOLCOTT ST
Practice Address - Street 2:39
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6469
Practice Address - Country:US
Practice Address - Phone:860-543-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional