Provider Demographics
NPI:1568610111
Name:KORSUNSKY, SARAH ROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ROSE
Last Name:KORSUNSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 S AMPHLETT BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2512
Mailing Address - Country:US
Mailing Address - Phone:650-349-7969
Mailing Address - Fax:650-349-1103
Practice Address - Street 1:1670 S AMPHLETT BLVD STE 115
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2512
Practice Address - Country:US
Practice Address - Phone:650-349-7969
Practice Address - Fax:650-349-1103
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical