| NPI | 1902089238 |
|---|---|
| Former Name | SHANNON KATHLEEN CORCORAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 403004) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 082228-1) |
| 163W00000X Registered Nurse (Licence: NY 740606) | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2021-02-25 |