Provider Demographics
NPI:1447316575
Name:CORFMAN, MARY E (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CORFMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032-0134
Mailing Address - Country:US
Mailing Address - Phone:269-625-4111
Mailing Address - Fax:269-544-0510
Practice Address - Street 1:227 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-9535
Practice Address - Country:US
Practice Address - Phone:269-625-4111
Practice Address - Fax:269-544-0510
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI62-39475OtherIBA HEALTH AND LIFE