Provider Demographics
NPI:1447680780
Name:CORBAE, JEAN (MA)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:CORBAE
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 1:9410 CROCUS CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5483
Mailing Address - Country:US
Mailing Address - Phone:239-440-2259
Mailing Address - Fax:
Practice Address - Street 1:9410 CROCUS CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5483
Practice Address - Country:US
Practice Address - Phone:239-440-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 10921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health