Healthcare Provider Details

I. General information

NPI: 1891329462
Provider Name (Legal Business Name): NORA KOHRI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368
JP

IV. Provider business mailing address

PSC 80 BOX 11394
APO AP
96367-0016
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-0433
  • Fax:
Mailing address:
  • Phone: 315-634-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001757
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: