MEDICARE: BARBRA CORCORAN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACB0005948	CO
2	1041C0700X	Clinical Social Worker	CSW.9925718	CO

General Provider Information

NPI Number	:	1861930588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBRA CORCORAN

Provider Business Mailing Address
First Line	:	PO BOX 2270
Second Line	:	ATTN PFS PAYER ENROLLMENT
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81602-2270
Country	:	US
Telephone Number	:	970-945-2238
Fax Number	:	970-928-8926

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVE STE 208
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4261
Country	:	US
Telephone Number	:	970-945-2238
Fax Number	:	970-928-8926

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

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	03/13/2024

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