MEDICARE: MARINA KORENSHTEYN 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	R053046	NY

General Provider Information

NPI Number	:	1700087830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA KORENSHTEYN LCSW

Provider Business Mailing Address
First Line	:	3 HARDWOOD DR
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-1108
Country	:	US
Telephone Number	:	845-680-9467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 50TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3332
Country	:	US
Telephone Number	:	845-680-9467
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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