Healthcare Provider Details

I. General information

NPI: 1558571513
Provider Name (Legal Business Name): KRISTEN H SOROCCO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN HILLIARD

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST OUPB 4300
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

1122 NE 13TH ST ORI236
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-3050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number947
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: