Provider Demographics
NPI:1730283300
Name:CORLIN, LAURIE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:M
Last Name:CORLIN
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 1:1307 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4819
Mailing Address - Country:US
Mailing Address - Phone:718-951-9025
Mailing Address - Fax:
Practice Address - Street 1:1358 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4616
Practice Address - Country:US
Practice Address - Phone:718-851-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO24085-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRO24085-1OtherCLINICAL SOCIAL WORKER