Basic Information
| Provider Information | |||||||||
| NPI: | 1649523176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORBIN | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 JFK DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 180 JFK DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2012 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | SW10944 | FL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | SW10944 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | SW10944 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | SW10944 | 01 | FL | LCSW | OTHER |