Healthcare Provider Details

I. General information

NPI: 1881737013
Provider Name (Legal Business Name): AMY ROSE KORN LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 OLD COUNTRY RD # 308
PLAINVIEW NY
11803-5021
US

IV. Provider business mailing address

11 PATRI CT
DIX HILLS NY
11746-8320
US

V. Phone/Fax

Practice location:
  • Phone: 631-499-0988
  • Fax: 631-462-1159
Mailing address:
  • Phone: 631-462-1159
  • Fax: 631-462-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO62773-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: