Provider Demographics
NPI:1710575857
Name:KOREN, AINAT (PHD, DNP, PMHNP)
Entity Type:Individual
Prefix:DR
First Name:AINAT
Middle Name:
Last Name:KOREN
Suffix:
Gender:F
Credentials:PHD, DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 WASHINGTON ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3011
Mailing Address - Country:US
Mailing Address - Phone:781-591-0663
Mailing Address - Fax:
Practice Address - Street 1:575 WASHINGTON ST STE 2D
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3011
Practice Address - Country:US
Practice Address - Phone:978-549-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255538363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty