Provider Demographics
NPI:1023356094
Name:CORCORAN, JACQUELINE (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 37TH RD N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-4517
Mailing Address - Country:US
Mailing Address - Phone:703-533-0893
Mailing Address - Fax:
Practice Address - Street 1:817A KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3016
Practice Address - Country:US
Practice Address - Phone:703-405-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040049991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical