Provider Demographics
NPI:1912347113
Name:CORCORAN, TRISCHANN LEONA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRISCHANN
Middle Name:LEONA
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E NEW YORK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2367
Mailing Address - Country:US
Mailing Address - Phone:929-400-2994
Mailing Address - Fax:
Practice Address - Street 1:10 E NEW YORK AVE STE 1
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2367
Practice Address - Country:US
Practice Address - Phone:929-400-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSW-GTL-20-01228104100000X
NJ18KT00519200225700000X
NJ44SC063478001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist