Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 102L00000X | Psychologist | PSY28591 | CA |
Y | 103T00000X | Psychologist | PSY28591 | CA |
NPI | 1013323476 |
---|---|
Provider Name | Julia Corcoran |
First Address | Menlo Park, CA 94025-4807 |
Second Address | Menlo Park, CA 94025-4807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 25/08/2016 |