Provider Demographics
NPI:1134396641
Name:CORBIN, JESSE CYR (LCSW)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:CYR
Last Name:CORBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-7736
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:15 MID COAST DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6079
Practice Address - Country:US
Practice Address - Phone:207-338-2295
Practice Address - Fax:207-338-2388
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432298899Medicaid
ME000722502Medicare PIN