Provider Demographics
NPI:1063609311
Name:CORLISS, STEPHANIE ANN (MS LMHC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:CORLISS
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PLANTATION ST
Mailing Address - Street 2:C/O YOU INC
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3069
Mailing Address - Country:US
Mailing Address - Phone:508-890-6519
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 560
Practice Address - Street 2:C/O YOU INC
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1817
Practice Address - Country:US
Practice Address - Phone:508-890-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health