Provider Demographics
NPI:1588862767
Name:CORCORAN, KATHLEEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2893 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3664
Mailing Address - Country:US
Mailing Address - Phone:305-297-1926
Mailing Address - Fax:
Practice Address - Street 1:2893 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3664
Practice Address - Country:US
Practice Address - Phone:305-297-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical