Healthcare Provider Details

I. General information

NPI: 1700268307
Provider Name (Legal Business Name): CAROLYN KORBEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ORCHARD SUITE 103
LAKE FOREST CA
92630-8320
US

IV. Provider business mailing address

31 SAN SEBASTIAN
RANCHO SANTA MARGARITA CA
92688-2506
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-3358
  • Fax: 949-837-0274
Mailing address:
  • Phone: 949-837-3358
  • Fax: 949-837-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY25176
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25176
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: