Provider Demographics
NPI:1790836757
Name:CORTE, PAUL E (CSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:CORTE
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 GAMEWOOD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9354
Mailing Address - Country:US
Mailing Address - Phone:248-486-7976
Mailing Address - Fax:
Practice Address - Street 1:10603 GAMEWOOD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9354
Practice Address - Country:US
Practice Address - Phone:248-486-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010654081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800895636OtherBCBS
MI0N10310Medicare PIN