Healthcare Provider Details

I. General information

NPI: 1407164437
Provider Name (Legal Business Name): PATRICIA L KORENCHEN MSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 MALAGUENA LN NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-8496
  • Fax:
Mailing address:
  • Phone: 505-271-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberX-06988
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC08243
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: