Provider Demographics
NPI:1104035286
Name:CORBY, MERINA (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MERINA
Middle Name:
Last Name:CORBY
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MASONIC ST UNIT 1693
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-7768
Mailing Address - Country:US
Mailing Address - Phone:860-912-7105
Mailing Address - Fax:
Practice Address - Street 1:125 SHAW ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4900
Practice Address - Country:US
Practice Address - Phone:860-912-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
CT001255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist