MEDICARE: DR. MARIANNE Y. CORCORAN PSYD

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
1	103TC0700X	Clinical Psychologist	071008343	IL

General Provider Information

NPI Number	:	1538316161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE Y. CORCORAN PSYD

Provider Business Mailing Address
First Line	:	739 S ROOSEVELT AVE
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2747
Country	:	US
Telephone Number	:	847-903-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 S ARLINGTON HEIGHTS RD STE 110
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4150
Country	:	US
Telephone Number	:	847-903-1707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	10/31/2021

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