Healthcare Provider Details

I. General information

NPI: 1164091591
Provider Name (Legal Business Name): JILLIAN GURBA KORB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 N OCEAN AVE
MEDFORD NY
11763-2649
US

IV. Provider business mailing address

90 CHERRY LN
HICKSVILLE NY
11801-6232
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-1919
  • Fax:
Mailing address:
  • Phone: 516-733-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101345
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: