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General NPI Number Information
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NPI Number | 1104142694
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Entity Type | Individual
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Provider Name | HEIDI KORINKO MA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 221 WILLOW ST
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City | YARMOUTH PORT
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State | MA
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Zip | 02675-1770
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Country | US
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Telephone | 508-771-2402
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Fax | 508-771-2101
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Provider Business Mailing Address
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Address Line | 55 PONDVIEW AVE
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City | WEST YARMOUTH
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State | MA
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Zip | 02673-3217
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Country | US
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Telephone | 508-778-1211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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