Provider Demographics
NPI:1609051432
Name:CORCORAN, THOMAS JOSEPH
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
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 1:1104 HAWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2506
Mailing Address - Country:US
Mailing Address - Phone:267-975-8251
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:RM 821
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor