MEDICARE: BENJAMIN G KORMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	04335	TX

General Provider Information

NPI Number	:	1245229830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN G KORMAN LCSW

Provider Business Mailing Address
First Line	:	1151 W PIONEER PKWY
Second Line	:	SUITE 100
City	:	ARLINGTON
State	:	TX
Zip	:	76013-7600
Country	:	US
Telephone Number	:	817-548-9500
Fax Number	:	817-548-1155

Provider Business Practice Location Address
First Line	:	1151 W PIONEER PKWY
Second Line	:	SUITE 100
City	:	ARLINGTON
State	:	TX
Zip	:	76013-7600
Country	:	US
Telephone Number	:	817-548-9500
Fax Number	:	817-548-1155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/13/2010

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