Provider Demographics
NPI:1417980574
Name:KORN, DEBORAH L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:KORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CONCORD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1337
Mailing Address - Country:US
Mailing Address - Phone:617-492-5050
Mailing Address - Fax:617-441-2590
Practice Address - Street 1:240 CONCORD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1337
Practice Address - Country:US
Practice Address - Phone:617-492-5050
Practice Address - Fax:617-441-2590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000W05639OtherBCBS OF MA PROVIDER NO.
MA0000W05639OtherBCBS OF MA PROVIDER NO.