Provider Demographics
NPI:1336192517
Name:CORBIN, PAMELA K (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:CORBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8587 S MASON MONTGOMERY RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9233
Mailing Address - Country:US
Mailing Address - Phone:513-919-6722
Mailing Address - Fax:513-282-0876
Practice Address - Street 1:8587 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9233
Practice Address - Country:US
Practice Address - Phone:513-919-6722
Practice Address - Fax:513-282-0876
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical