Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 098293-1 | NY |
NPI | 1003447533 |
---|---|
Provider Name | Olivia Korn |
First Address | New York, NY 10012-1901 |
Second Address | New York, NY 10012-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2020 |
Last Update Date | 03/02/2020 |