=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497032007
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANNA KORBY LMHC, CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2011
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 MARKET ST
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-321-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 MARKET ST
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-321-5644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 004770-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 004770-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------