Provider Demographics
NPI:1639919673
Name:CORGIAT, SUZANNE (MA IN PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CORGIAT
Suffix:
Gender:F
Credentials:MA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27990 YOSEMITE SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9238
Mailing Address - Country:US
Mailing Address - Phone:205-639-9192
Mailing Address - Fax:
Practice Address - Street 1:103 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4895
Practice Address - Country:US
Practice Address - Phone:209-533-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist