Provider Demographics
NPI:1699782540
Name:CORKINS, CAREN (LCSW (LMSW-ACP))
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:CORKINS
Suffix:
Gender:F
Credentials:LCSW (LMSW-ACP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 CENTERGATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4802
Mailing Address - Country:US
Mailing Address - Phone:210-299-2476
Mailing Address - Fax:210-657-3095
Practice Address - Street 1:4245 CENTERGATE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4802
Practice Address - Country:US
Practice Address - Phone:210-299-2476
Practice Address - Fax:210-657-3095
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX096311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00413EOtherUNSPECIFIED
TX108108503Medicaid
TXR7566Medicare UPIN