Provider Demographics
NPI:1649523176
Name:CORBIN, RONALD J (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
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 1:180 JFK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6607
Mailing Address - Country:US
Mailing Address - Phone:561-548-1450
Mailing Address - Fax:
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6607
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10944101YA0400X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW10944OtherLCSW