Provider Demographics
NPI:1609690627
Name:CORCORAN, LAURA KATHERINE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:KATHERINE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:KATHERINE
Other - Last Name:SCULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3231
Mailing Address - Country:US
Mailing Address - Phone:516-382-4407
Mailing Address - Fax:
Practice Address - Street 1:6 EVERETT ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3231
Practice Address - Country:US
Practice Address - Phone:516-382-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406483363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health