Active NPI
Jesse Cyr Corbin, LCSW
- Clinical Social Worker
- Belfast, ME
National Provider Identifier
1134396641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC11595
- Practice address
- 15 Mid Coast Dr
Belfast, ME 04915-6079 - Phone
- (207) 338-2295
- Fax
- (207) 338-2388
- NPI assigned
- May 14, 2008
- Last updated
- Feb 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC11595 | ME | Primary |
Addresses
Primary practice location
15 Mid Coast Dr
Belfast, ME 04915-6079
Mailing address
78 Atlantic PL
South Portland, ME 04106-2316
Phone (207) 842-7736
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 432298899 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC11595 | ME | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361318400000",
"number": "1134396641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "78 ATLANTIC PL",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041062316",
"telephone_number": "207-842-7736",
"fax_number": "207-842-7773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 MID COAST DR",
"city": "BELFAST",
"state": "ME",
"postal_code": "049156079",
"telephone_number": "207-338-2295",
"fax_number": "207-338-2388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORBIN",
"first_name": "JESSE",
"middle_name": "CYR",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-14",
"last_updated": "2013-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ME",
"license": "LC11595",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "432298899",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belfast, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.