Provider Demographics
NPI:1023048642
Name:CORLEY, KIMBERLY (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W CANAL ST
Mailing Address - Street 2:SUITE C-11
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2131
Mailing Address - Country:US
Mailing Address - Phone:802-651-7520
Mailing Address - Fax:
Practice Address - Street 1:20 W CANAL ST
Practice Address - Street 2:SUITE C-11
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2131
Practice Address - Country:US
Practice Address - Phone:802-651-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical