Provider Demographics
NPI:1396730024
Name:CORRIGAN, LARRY W (LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:W
Last Name:CORRIGAN
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 CLAIREMONT MESA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1320
Mailing Address - Country:US
Mailing Address - Phone:858-565-8303
Mailing Address - Fax:858-565-0630
Practice Address - Street 1:8340 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1320
Practice Address - Country:US
Practice Address - Phone:858-565-8303
Practice Address - Fax:858-565-0630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CALCS66751041C0700X
CAMFC8186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist