Provider Demographics
NPI:1558402750
Name:KORN-BURSZTYN, CAROL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:KORN-BURSZTYN
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 1:550 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3003
Mailing Address - Country:US
Mailing Address - Phone:718-832-3169
Mailing Address - Fax:
Practice Address - Street 1:550 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3003
Practice Address - Country:US
Practice Address - Phone:718-832-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010388-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist