Individual ProviderCharles Joseph CorballySocial WorkerBehavioral Health & Social Service ProvidersPractice Address2 Church St, Suite 3g, Burlington, VT 05401-4299(802) 281-3330PECOS EnrollmentBased on the most recent information from CMS, provider Charles Joseph Corbally does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1225584980Provider TypeIndividualFull NameCorbally, Charles JosephCredentialLICSWGenderMaleSole ProprietorYesEnumeration Date8/31/2016Last Updated4/17/2017Contact InformationPractice LocationPractice Address2 Church St, Suite 3g, Burlington, VT 05401-4299Phone(802) 281-3330FaxUnlisted FaxMailing LocationMailing Address2 Church Street, Suite 3g, Burlington, VT 05401Phone(802) 281-3330FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense089.0117025VermontProvider IdentifiersIDDescriptionIssuerID1028428DescriptionMedicaidIssuerUnlistedVermont