Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373614 |
---|---|
Provider Name | Patrick Corcoran |
First Address | Media, PA 19063-2574 |
Second Address | Media, PA 19063-2574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 01/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-19-76001 | BACB REGISTRATION NUMBER (01) |