Provider Demographics
NPI:1619357506
Name:KORCZAK, ZBIGNIEW MAREK (LMSW)
Entity Type:Individual
Prefix:
First Name:ZBIGNIEW
Middle Name:MAREK
Last Name:KORCZAK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 58TH AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3224
Mailing Address - Country:US
Mailing Address - Phone:347-730-8160
Mailing Address - Fax:
Practice Address - Street 1:5992 58TH AVE
Practice Address - Street 2:APT. 2
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3224
Practice Address - Country:US
Practice Address - Phone:347-730-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker