Provider Demographics
NPI:1992206049
Name:CORSO, STEPHEN ELIOT (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ELIOT
Last Name:CORSO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BATES ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2833
Mailing Address - Country:US
Mailing Address - Phone:774-217-1496
Mailing Address - Fax:
Practice Address - Street 1:10 BATES ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2833
Practice Address - Country:US
Practice Address - Phone:774-217-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1057781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical