Provider Demographics
NPI:1366800757
Name:SEVILLE, CORINNE R (PSYD)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:R
Last Name:SEVILLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5323
Mailing Address - Country:US
Mailing Address - Phone:203-362-3933
Mailing Address - Fax:203-362-2463
Practice Address - Street 1:2400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5323
Practice Address - Country:US
Practice Address - Phone:203-362-3933
Practice Address - Fax:203-362-2463
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist