Provider Demographics
NPI:1245229830
Name:KORMAN, BENJAMIN G (LCSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:KORMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 W PIONEER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7600
Mailing Address - Country:US
Mailing Address - Phone:817-548-9500
Mailing Address - Fax:817-548-1155
Practice Address - Street 1:1151 W PIONEER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7600
Practice Address - Country:US
Practice Address - Phone:817-548-9500
Practice Address - Fax:817-548-1155
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX043351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6624Medicare ID - Type Unspecified