Provider Demographics
NPI:1770052490
Name:FORTUNE, CORRYN (LCSW)
Entity type:Individual
Prefix:
First Name:CORRYN
Middle Name:
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORRYN
Other - Middle Name:
Other - Last Name:ANDRIANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:401 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3854
Mailing Address - Country:US
Mailing Address - Phone:518-431-1650
Mailing Address - Fax:518-447-0429
Practice Address - Street 1:401 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3854
Practice Address - Country:US
Practice Address - Phone:518-431-1650
Practice Address - Fax:518-447-0429
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0938981041C0700X
NY104773104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical