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General NPI Number Information
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NPI Number | 1497092985
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Entity Type | Individual
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Provider Name | COURTNEY ANN CORRADO PSY.D
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Gender | Female
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Dates
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Enumeration Date | 01/03/2013
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 1 MAIN ST
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City | SAN QUENTIN
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State | CA
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Zip | 94964-1000
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Country | US
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Telephone | 773-531-4737
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Fax |
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Provider Business Mailing Address
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Address Line | PO. BOX 35
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City | SAN QUENTIN
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State | CA
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Zip | 94964
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Country | US
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Telephone | 773-531-4737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY26210
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License Number State | CA
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