Organization
MIRIAM J. CORCORAN, PH.D., INC.
Active
Parent organization
MIRIAM J. CORCORAN, PH.D., INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIRIAM J. CORCORAN, PH.D., INC.
Authorized official
MS. MIRIIAM J CORCORAN PH.D. (PRESIDENT)
(505) 255-4012
Entity
Organization
Contact information
Practice address
201 TULANE DR SE, ALBUQUERQUE, NM 87106-1413
(505) 255-4012
(505) 255-4130
Mailing address
201 TULANE DR SE, ALBUQUERQUE, NM 87106-1413
(505) 255-4012
(505) 255-4130
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
478
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM00NE75
BLUE CROSS OF NM
NM
Enumeration date
09/24/2008
Last updated
09/24/2008
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