Provider Demographics
NPI:1235538695
Name:KORESH, DANA (LMSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KORESH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CAMPUS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2153
Mailing Address - Country:US
Mailing Address - Phone:800-683-2616
Mailing Address - Fax:718-504-4811
Practice Address - Street 1:2901 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2153
Practice Address - Country:US
Practice Address - Phone:800-683-2616
Practice Address - Fax:718-504-4811
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091480-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor