Provider Demographics
NPI:1376550475
Name:KORB, KATHLEEN LOUISE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:KORB
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-9794
Mailing Address - Country:US
Mailing Address - Phone:802-254-7030
Mailing Address - Fax:
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1150
Practice Address - Country:US
Practice Address - Phone:978-544-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health