Provider Demographics
NPI:1346579091
Name:CORWIN, AMY BERUBE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BERUBE
Last Name:CORWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:BERUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:180 RIDGEWAY AVE
Mailing Address - Street 2:JOHN MARSHALL HIGH SCHOOL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3636
Mailing Address - Country:US
Mailing Address - Phone:585-458-2110
Mailing Address - Fax:585-458-8092
Practice Address - Street 1:180 RIDGEWAY AVE
Practice Address - Street 2:JOHN MARSHALL HIGH SCHOOL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3636
Practice Address - Country:US
Practice Address - Phone:585-458-2110
Practice Address - Fax:585-458-8092
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical