MEDICARE: MR. ALEX PERRY CORKOS L.M.F.T.

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	106H00000X	Marriage & Family Therapist	MF000365	PA
2	106H00000X	Marriage & Family Therapist	MFC25400	CA

General Provider Information

NPI Number	:	1992939862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEX PERRY CORKOS L.M.F.T.

Provider Business Mailing Address
First Line	:	106 RIDGEVIEW DR
Second Line	:
City	:	VENETIA
State	:	PA
Zip	:	15367-1223
Country	:	US
Telephone Number	:	412-567-3930
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 WASHINGTON RD
Second Line	:	SUITE 2
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2534
Country	:	US
Telephone Number	:	412-567-3930
Fax Number	:

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	05/07/2009

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