Provider Demographics
NPI:1407070469
Name:KORB, JENNIFER HOGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOGAN
Last Name:KORB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 NEWPORT PKWY APT 1512
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2306
Mailing Address - Country:US
Mailing Address - Phone:646-820-9298
Mailing Address - Fax:212-320-0636
Practice Address - Street 1:274 MADISON AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0701
Practice Address - Country:US
Practice Address - Phone:646-820-9298
Practice Address - Fax:212-320-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0785871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical