Provider Demographics
NPI:1821689407
Name:KORINE, PERRI
Entity Type:Individual
Prefix:
First Name:PERRI
Middle Name:
Last Name:KORINE
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 1:7 VANDERBILT PKWY
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5813
Mailing Address - Country:US
Mailing Address - Phone:631-848-3272
Mailing Address - Fax:
Practice Address - Street 1:7 VANDERBILT PKWY
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5813
Practice Address - Country:US
Practice Address - Phone:631-848-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095918-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker