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NPI Code Detail

MEDICARE: DR. KATHERINE CORCORAN PHD

MEDICARE: DR. KATHERINE CORCORAN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist2032057WI
2103TC0700XClinical Psychologist071005494IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3680016241OTHERILR & R MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001626099OTHERILBCBS
2196774000OTHERILMIS # BCBS/MAG
426889122OTHERTRICARE
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467467894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHERINE CORCORAN PHD
Provider Business Mailing Address
First Line : 2434 N FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-1806
Country : US
Telephone Number : 773-235-0379
Fax Number :
Provider Business Practice Location Address
First Line : 2434 N FAIRFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-1806
Country : US
Telephone Number : 773-235-0379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 08/30/2008

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