Provider Demographics
NPI:1376956987
Name:CORBIN, DANIELLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 RIFLE CAMP ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2726
Mailing Address - Country:US
Mailing Address - Phone:201-321-0911
Mailing Address - Fax:
Practice Address - Street 1:365 RIFLE CAMP RD FL 2
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2726
Practice Address - Country:US
Practice Address - Phone:201-321-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00142400101YM0800X
NJ37PC00578600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health