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General NPI Number Information
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NPI Number | 1346315561
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Entity Type | Individual
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Provider Name | JUDITH RHEA KORN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 6108 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-4474
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Country | US
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Telephone | 941-718-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 6108 26TH ST WEST SUITE 3B
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City | BRADENTON
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State | FL
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Zip | 34207
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Country | US
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Telephone | 941-953-8515
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Fax | 941-727-8120
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW SW0002609
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License Number State | FL
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