Provider Demographics
NPI:1366691420
Name:SERRANO, CORBY
Entity Type:Individual
Prefix:
First Name:CORBY
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 5TH AVE
Mailing Address - Street 2:SUITE 903
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:212-633-9162
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-633-9162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health