Provider Demographics
NPI:1346315561
Name:KORN, JUDITH RHEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:RHEA
Last Name:KORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 26TH ST WEST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207
Mailing Address - Country:US
Mailing Address - Phone:941-953-8515
Mailing Address - Fax:941-727-8120
Practice Address - Street 1:6108 26TH ST WEST
Practice Address - Street 2:SUITE 3B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207
Practice Address - Country:US
Practice Address - Phone:941-953-8515
Practice Address - Fax:941-727-8120
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW SW00026091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
24676Medicare ID - Type Unspecified