Provider Demographics
NPI:1790394211
Name:KORBA, JARRAH
Entity Type:Individual
Prefix:
First Name:JARRAH
Middle Name:
Last Name:KORBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 BOYLSTON ST UNIT 811
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4460
Mailing Address - Country:US
Mailing Address - Phone:847-736-0323
Mailing Address - Fax:
Practice Address - Street 1:405 5TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5713
Practice Address - Country:US
Practice Address - Phone:310-310-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst