Provider Demographics
NPI:1740413368
Name:CORCORRAN, LAURA DEPP (MFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DEPP
Last Name:CORCORRAN
Suffix:
Gender:
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3624
Mailing Address - Country:US
Mailing Address - Phone:818-397-0636
Mailing Address - Fax:
Practice Address - Street 1:6425 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3624
Practice Address - Country:US
Practice Address - Phone:818-397-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist