Provider Demographics
NPI:1164314340
Name:CORSO, CLAIRE-MADELINE
Entity type:Individual
Prefix:
First Name:CLAIRE-MADELINE
Middle Name:
Last Name:CORSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 MAPLE TREE PL # 1024
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20500 WARRIORS WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:VA
Practice Address - Zip Code:22514-2867
Practice Address - Country:US
Practice Address - Phone:804-529-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health