Provider Demographics
NPI:1730379454
Name:THOMAS, CORRINE (LCSW)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 E MAIN ST
Mailing Address - Street 2:# E123
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2820
Mailing Address - Country:US
Mailing Address - Phone:702-328-4612
Mailing Address - Fax:702-684-6448
Practice Address - Street 1:2674 E MAIN ST
Practice Address - Street 2:# E123
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2820
Practice Address - Country:US
Practice Address - Phone:702-328-4612
Practice Address - Fax:702-684-6448
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical