Provider Demographics
NPI:1063176691
Name:EVANCOE, CORINNA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:MARIE
Last Name:EVANCOE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:MARIE
Other - Last Name:DOCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NY
Mailing Address - Zip Code:13743-0145
Mailing Address - Country:US
Mailing Address - Phone:607-659-5020
Mailing Address - Fax:
Practice Address - Street 1:1 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CANDOR
Practice Address - State:NY
Practice Address - Zip Code:13743
Practice Address - Country:US
Practice Address - Phone:697-659-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0918331041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool