=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114501624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE GRACE CORCORAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2021
-----------------------------------------------------
Last Update Date | 05/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 W OJAI AVE STE 101
-----------------------------------------------------
City | OJAI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93023-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-417-1346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 W OJAI AVE STE 101
-----------------------------------------------------
City | OJAI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93023-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 454-171-3468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 125202
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------