Individual
DR. KATHERINE CORCORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2434 N FAIRFIELD AVE, CHICAGO, IL 60647-1806
(773) 235-0379
Mailing address
2434 N FAIRFIELD AVE, CHICAGO, IL 60647-1806
(773) 235-0379
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2032057
WI
103TC0700X
Clinical Psychologist
Primary
071005494
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001626099
BCBS
IL
01
—
196774000
MIS # BCBS/MAG
IL
01
—
26889122
TRICARE
—
05
—
39747700
—
WI
01
—
680016241
R & R MEDICARE
IL
Enumeration date
07/31/2006
Last updated
08/30/2008
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