Provider Demographics
NPI:1699398917
Name:RICHARD LC CORFMAN
Entity Type:Organization
Organization Name:RICHARD LC CORFMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LC
Authorized Official - Last Name:CORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-513-5908
Mailing Address - Street 1:2600 DODGE ST
Mailing Address - Street 2:STE D4, UNIT 25
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7161
Mailing Address - Country:US
Mailing Address - Phone:563-513-5908
Mailing Address - Fax:563-588-3834
Practice Address - Street 1:2600 DODGE ST
Practice Address - Street 2:STE D4, UNIT 25
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7161
Practice Address - Country:US
Practice Address - Phone:563-513-5908
Practice Address - Fax:563-588-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty