Provider Demographics
NPI:1063231686
Name:MAI, CORBIN (LSW)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 FARMINGTON LAKES DR APT 11
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8084
Mailing Address - Country:US
Mailing Address - Phone:970-589-1862
Mailing Address - Fax:
Practice Address - Street 1:1754 N WASHINGTON ST STE 104A
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1462
Practice Address - Country:US
Practice Address - Phone:630-995-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.114541104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker