Provider Demographics
NPI:1861592107
Name:CORSO, KENT ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:CORSO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 NAVAJO TRCE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9593
Mailing Address - Country:US
Mailing Address - Phone:850-883-8373
Mailing Address - Fax:850-883-8330
Practice Address - Street 1:307 BOATNER RD
Practice Address - Street 2:SUITE 114, BLDG. 1
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1391
Practice Address - Country:US
Practice Address - Phone:850-883-8373
Practice Address - Fax:850-883-8330
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist