Provider Demographics
NPI:1538219555
Name:CORBETT, CHANDA CARMELA (PHD)
Entity type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:CARMELA
Last Name:CORBETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 DANIELS AVERNUE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207
Mailing Address - Country:US
Mailing Address - Phone:603-591-0149
Mailing Address - Fax:410-788-3220
Practice Address - Street 1:3545 ELLICOTT MILLS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4548
Practice Address - Country:US
Practice Address - Phone:603-591-0149
Practice Address - Fax:410-788-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04648103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD029219200Medicaid