Provider Demographics
NPI:1124068143
Name:THURSTAN, CORINNE G (LCSW)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:G
Last Name:THURSTAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORRINE
Other - Middle Name:G
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:179 GRAYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1614
Mailing Address - Country:US
Mailing Address - Phone:860-377-7773
Mailing Address - Fax:860-228-5232
Practice Address - Street 1:179 GRAYVILLE RD
Practice Address - Street 2:
Practice Address - City:AMSTON
Practice Address - State:CT
Practice Address - Zip Code:06231-1614
Practice Address - Country:US
Practice Address - Phone:860-377-7773
Practice Address - Fax:860-228-5232
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0039701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical