Healthcare Provider Details

I. General information

NPI: 1437874500
Provider Name (Legal Business Name): ALYSSA MARIE KORMAN LCAT-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 E 32ND ST FL 10
NEW YORK NY
10016-5562
US

IV. Provider business mailing address

38 E 32ND ST FL 10
NEW YORK NY
10016-5562
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-3739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License NumberP117916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: