Provider Demographics
NPI:1518308196
Name:KORN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EASTBROOK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-2075
Mailing Address - Country:US
Mailing Address - Phone:781-329-9365
Mailing Address - Fax:781-302-4635
Practice Address - Street 1:20 EASTBROOK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2075
Practice Address - Country:US
Practice Address - Phone:781-329-9365
Practice Address - Fax:781-302-4635
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health