Provider Demographics
NPI:1134565245
Name:CORBETT, ANGELA L (LCSW, CAP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:L
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:JACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCSWI, CAP
Mailing Address - Street 1:1202 FLORABLU DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3531
Mailing Address - Country:US
Mailing Address - Phone:813-419-3386
Mailing Address - Fax:
Practice Address - Street 1:6338 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:813-419-3386
Practice Address - Fax:813-793-4879
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW67121041C0700X
FLSW114361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical