Provider Demographics
NPI:1073611166
Name:ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ALBERT CORBIN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-919-6722
Mailing Address - Street 1:8587 S. MASON MONTGOMERY RD.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9317
Mailing Address - Country:US
Mailing Address - Phone:513-919-6722
Mailing Address - Fax:513-282-0876
Practice Address - Street 1:8587 S. MASON MONTGOMERY RD.
Practice Address - Street 2:SUITE 9
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9317
Practice Address - Country:US
Practice Address - Phone:513-919-6722
Practice Address - Fax:513-282-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty