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General NPI Number Information
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NPI Number | 1407070469
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Entity Type | Individual
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Provider Name | JENNIFER HOGAN KORB LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 274 MADISON AVE SUITE 1500
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City | NEW YORK
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State | NY
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Zip | 10016-0701
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Country | US
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Telephone | 646-820-9298
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Fax | 212-320-0636
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Provider Business Mailing Address
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Address Line | 20 NEWPORT PKWY APT 1512
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City | JERSEY CITY
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State | NJ
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Zip | 07310-2306
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Country | US
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Telephone | 646-820-9298
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Fax | 212-320-0636
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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 | 078587
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License Number State | NY
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