Provider Demographics
NPI:1073750428
Name:KORCHMA, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:KORCHMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SKYLINE TER
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1009
Mailing Address - Country:US
Mailing Address - Phone:914-592-8526
Mailing Address - Fax:914-592-5321
Practice Address - Street 1:5 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2154
Practice Address - Country:US
Practice Address - Phone:914-592-8526
Practice Address - Fax:914-592-5321
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-00-0242103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst