Provider Demographics
NPI:1457869208
Name:CORBIN, KENNETH FRANCIS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:FRANCIS
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 1:26 E MINERVA RD
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6819
Mailing Address - Country:US
Mailing Address - Phone:631-416-4308
Mailing Address - Fax:
Practice Address - Street 1:26 E MINERVA RD
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6819
Practice Address - Country:US
Practice Address - Phone:631-416-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0708541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical