Provider Demographics
NPI:1689065815
Name:CORSON, ROY STEPHAN (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:STEPHAN
Last Name:CORSON
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 KIEL AVE # 314
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2572
Mailing Address - Country:US
Mailing Address - Phone:973-750-4111
Mailing Address - Fax:973-291-4858
Practice Address - Street 1:2 KIEL AVE # 314
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2572
Practice Address - Country:US
Practice Address - Phone:973-750-4111
Practice Address - Fax:973-291-4858
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00511900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health