Provider Demographics
NPI:1598779092
Name:KORICKE, DEBORAH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:KORICKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 WESTGATE PROFESSIONAL CENTER
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126
Mailing Address - Country:US
Mailing Address - Phone:440-333-4949
Mailing Address - Fax:440-333-5044
Practice Address - Street 1:20800 WESTGATE PROFESSIONAL CENTER
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:440-333-4949
Practice Address - Fax:440-333-5044
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704250Medicaid
OHKOCP02641Medicare PIN