Provider Demographics
NPI:1972260164
Name:DIBELLO, CORRIE E (LCSW)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:E
Last Name:DIBELLO
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 1:630 W 170TH ST APT GG
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3515
Mailing Address - Country:US
Mailing Address - Phone:315-546-3727
Mailing Address - Fax:
Practice Address - Street 1:8725 136TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1924
Practice Address - Country:US
Practice Address - Phone:718-291-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0922551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical