Provider Demographics
NPI:1023824307
Name:CORBETT, CAMILLE (PSYD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:CORBETT
Suffix:
Gender:U
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S 49TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2283
Mailing Address - Country:US
Mailing Address - Phone:919-219-8885
Mailing Address - Fax:
Practice Address - Street 1:631 S 49TH ST APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2283
Practice Address - Country:US
Practice Address - Phone:919-219-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist