Provider Demographics
NPI:1548414964
Name:CORVINO, CAROLINE O (CNS, APN C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:O
Last Name:CORVINO
Suffix:
Gender:F
Credentials:CNS, APN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3906
Mailing Address - Country:US
Mailing Address - Phone:973-482-2774
Mailing Address - Fax:973-480-2870
Practice Address - Street 1:260 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3906
Practice Address - Country:US
Practice Address - Phone:973-482-2774
Practice Address - Fax:973-480-2870
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00173100364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent