Provider Demographics
NPI:1619334091
Name:CORK, MEGHAN (LCAT, MT-BC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CORK
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OCEAN PKWY
Mailing Address - Street 2:APT 5F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2460
Mailing Address - Country:US
Mailing Address - Phone:631-882-3331
Mailing Address - Fax:
Practice Address - Street 1:160 OCEAN PKWY
Practice Address - Street 2:APT 5F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2460
Practice Address - Country:US
Practice Address - Phone:631-882-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001828225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10435OtherTHE CERTIFICATION BOARD FOR MUSIC THERAPISTS