Provider Demographics
NPI:1073914297
Name:KORSAK, SAVARINTORN
Entity Type:Individual
Prefix:
First Name:SAVARINTORN
Middle Name:
Last Name:KORSAK
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 1:47-436 LULANI ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4717
Mailing Address - Country:US
Mailing Address - Phone:808-255-5185
Mailing Address - Fax:
Practice Address - Street 1:47-436 LULANI ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4717
Practice Address - Country:US
Practice Address - Phone:808-255-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist