Provider Demographics
NPI:1568096097
Name:PAPPERT-CORSINO, PATRICIA LYNN (LBS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:PAPPERT-CORSINO
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E BALTIMORE PIKE FL 2
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1751
Mailing Address - Country:US
Mailing Address - Phone:215-645-5408
Mailing Address - Fax:877-599-3340
Practice Address - Street 1:606 E BALTIMORE PIKE FL 2
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1751
Practice Address - Country:US
Practice Address - Phone:215-645-5408
Practice Address - Fax:877-599-3340
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004820103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH004820OtherBEHAVIOR SPECIALIST