Provider Demographics
NPI:1720396500
Name:CORBINE, KELLY SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUSAN
Last Name:CORBINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:CORBINE
Other - Last Name:KIMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:890 7TH NORTH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6558
Mailing Address - Country:US
Mailing Address - Phone:315-200-1056
Mailing Address - Fax:315-452-2455
Practice Address - Street 1:890 7TH NORTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6558
Practice Address - Country:US
Practice Address - Phone:315-200-1056
Practice Address - Fax:315-452-2455
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0753541041C0700X
NY8438901041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool