Provider Demographics
NPI:1578638490
Name:CORBETT, TRACY (MFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EAST MIDDLE TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-202-8453
Mailing Address - Fax:860-649-2484
Practice Address - Street 1:13 EAST MIDDLE TURNPIKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-202-8453
Practice Address - Fax:860-649-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional