Provider Demographics
NPI:1477345924
Name:CORCORAN, KEVIN C
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W OFFICE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3215
Mailing Address - Country:US
Mailing Address - Phone:484-354-0872
Mailing Address - Fax:
Practice Address - Street 1:500 W OFFICE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3215
Practice Address - Country:US
Practice Address - Phone:484-354-0872
Practice Address - Fax:484-354-0872
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-23-69956103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst