Provider Demographics
NPI:1467829358
Name:CORCORAN, SOFIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 WILLIAMSTOWNE
Mailing Address - Street 2:#10
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2322
Mailing Address - Country:US
Mailing Address - Phone:262-434-0540
Mailing Address - Fax:262-354-8429
Practice Address - Street 1:394 WILLIAMSTOWNE
Practice Address - Street 2:#10
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2322
Practice Address - Country:US
Practice Address - Phone:262-434-0540
Practice Address - Fax:262-354-8429
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1978101YP2500X
WI5788-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional