Provider Demographics
NPI:1063608024
Name:CORIC, KATHRYNE M (MSW)
Entity type:Individual
Prefix:
First Name:KATHRYNE
Middle Name:M
Last Name:CORIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHRYNE
Other - Middle Name:M
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:327 HOWARD AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5845
Mailing Address - Country:US
Mailing Address - Phone:716-945-5211
Mailing Address - Fax:716-945-5267
Practice Address - Street 1:97 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1529
Practice Address - Country:US
Practice Address - Phone:716-945-5211
Practice Address - Fax:716-945-5267
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635098Medicaid