Provider Demographics
NPI:1710079421
Name:KORN, JANIS HELEN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:HELEN
Last Name:KORN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:89 MAIN STREET
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-0113
Mailing Address - Country:US
Mailing Address - Phone:508-478-6725
Mailing Address - Fax:508-634-7065
Practice Address - Street 1:89 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-0113
Practice Address - Country:US
Practice Address - Phone:508-478-6725
Practice Address - Fax:508-634-7065
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1007121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KOPO2573Medicare ID - Type Unspecified