Provider Demographics
NPI:1679982128
Name:CORBITT, KELLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CORBITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 SOUTH STATE STREET, BUILDING A
Mailing Address - Street 2:NEWTOWN THERAPY AND WELLNESS CENTER
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:917-847-7073
Mailing Address - Fax:
Practice Address - Street 1:17 BARCLAY STREET
Practice Address - Street 2:BUILDING A
Practice Address - City:NEWTOWN
Practice Address - State:NJ
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:917-847-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054346001041C0700X
PACW0169971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical