Provider Demographics
NPI:1649427311
Name:CORBETT, SUSAN CAROLE (RN, CASAC, CACN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROLE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:RN, CASAC, CACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-19 SUSSEX STREET
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771
Mailing Address - Country:US
Mailing Address - Phone:845-856-6344
Mailing Address - Fax:845-856-4091
Practice Address - Street 1:17-19 SUSSEX STREET
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771
Practice Address - Country:US
Practice Address - Phone:845-856-6344
Practice Address - Fax:845-856-4091
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327966-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)