Provider Demographics
NPI:1336223510
Name:CORBETT, SUSAN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 GOLDENROD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5318
Mailing Address - Country:US
Mailing Address - Phone:941-365-9481
Mailing Address - Fax:941-365-9481
Practice Address - Street 1:2700 S TAMIAMI TRL
Practice Address - Street 2:11-A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4530
Practice Address - Country:US
Practice Address - Phone:941-365-9481
Practice Address - Fax:941-365-9481
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW#1411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2280Medicare ID - Type Unspecified