Provider Demographics
NPI:1275043978
Name:SAVAGE, CORVETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:CORVETTE
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 TAMIAMI TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1064
Mailing Address - Country:US
Mailing Address - Phone:941-249-4354
Mailing Address - Fax:941-249-4356
Practice Address - Street 1:1777 TAMIAMI TRL STE 201
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1064
Practice Address - Country:US
Practice Address - Phone:941-249-4354
Practice Address - Fax:941-249-4356
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist