Provider Demographics
NPI:1376159780
Name:CORCORAN, KRISTI (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CATHARINE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3398
Mailing Address - Country:US
Mailing Address - Phone:858-354-7561
Mailing Address - Fax:
Practice Address - Street 1:212 CATHARINE ST APT 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3398
Practice Address - Country:US
Practice Address - Phone:858-354-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100457200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical