Provider Demographics
NPI:1922603208
Name:VOTAW, CORINNE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:J
Last Name:VOTAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CORINNE
Other - Middle Name:J
Other - Last Name:FREER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:16001 LEGACY RD UNIT 410
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2778
Mailing Address - Country:US
Mailing Address - Phone:303-956-9684
Mailing Address - Fax:
Practice Address - Street 1:16001 LEGACY RD UNIT 410
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2778
Practice Address - Country:US
Practice Address - Phone:303-956-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2013009103TC1900X, 103TC2200X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily