Provider Demographics
NPI:1063724540
Name:CORBIN, MARY E (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:CORBIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10B CORBIN LN
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6365
Mailing Address - Country:US
Mailing Address - Phone:845-462-8164
Mailing Address - Fax:
Practice Address - Street 1:10B CORBIN LN
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6365
Practice Address - Country:US
Practice Address - Phone:845-462-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020019-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist