Provider Demographics
NPI:1568638096
Name:CORNE, SHAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:CORNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SOLANO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1009 SOLANO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1617
Practice Address - Country:US
Practice Address - Phone:510-903-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical