Provider Demographics
NPI:1730679671
Name:CORCORAN, ALEX PATRICK (MSSA, LSW)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:PATRICK
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 VINEYARD DR APT 101
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3334
Mailing Address - Country:US
Mailing Address - Phone:440-382-3700
Mailing Address - Fax:
Practice Address - Street 1:8227 BRECKSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1363
Practice Address - Country:US
Practice Address - Phone:440-526-0468
Practice Address - Fax:440-526-0454
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS16002801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical