Provider Demographics
NPI:1225236441
Name:CORCORAN, COLETTE LEE (MED, LMHC, ESQUIRE)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:LEE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:MED, LMHC, ESQUIRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SE 47TH TER
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9079
Mailing Address - Country:US
Mailing Address - Phone:239-549-5363
Mailing Address - Fax:239-549-5325
Practice Address - Street 1:885 SE 47TH TER
Practice Address - Street 2:SUITE D
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9079
Practice Address - Country:US
Practice Address - Phone:239-549-5363
Practice Address - Fax:239-549-5325
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health