Provider Demographics
NPI:1205231073
Name:CORBETT, SANDRA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CANYON RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9232
Mailing Address - Country:US
Mailing Address - Phone:304-598-4433
Mailing Address - Fax:304-594-0325
Practice Address - Street 1:6 CANYON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9232
Practice Address - Country:US
Practice Address - Phone:304-598-4433
Practice Address - Fax:304-594-0325
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009436751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical