Provider Demographics
NPI:1366593303
Name:CORBITT, TIMOTHY JAMES (LCSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:CORBITT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STOWE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13687-3425
Mailing Address - Country:US
Mailing Address - Phone:315-261-1172
Mailing Address - Fax:
Practice Address - Street 1:76 PARK ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1506
Practice Address - Country:US
Practice Address - Phone:315-229-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042381041C0700X
NY0798271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY079827OtherNYSED OFFICE OF THE PROFESSIONS