Provider Demographics
NPI:1275860058
Name:CORWIN, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CORWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WAYMONT CT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3586
Mailing Address - Country:US
Mailing Address - Phone:407-322-6868
Mailing Address - Fax:
Practice Address - Street 1:405 WAYMONT CT
Practice Address - Street 2:SUITE 111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3586
Practice Address - Country:US
Practice Address - Phone:407-322-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS346103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool