Provider Demographics
NPI:1609823616
Name:KORETSKY, PAMELA H
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:H
Last Name:KORETSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:KORETSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2517 HARPTREE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1606
Mailing Address - Country:US
Mailing Address - Phone:919-845-1392
Mailing Address - Fax:
Practice Address - Street 1:6200 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3563
Practice Address - Country:US
Practice Address - Phone:919-845-1392
Practice Address - Fax:919-845-1392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO28801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1101KOtherBCBS OF NC PROVIDER NUMBE
NC6002041Medicaid
NC2869277Medicare ID - Type Unspecified