Provider Demographics
NPI:1922382696
Name:KORRIE, ELIZABETH GRACE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:KORRIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:GRACE
Other - Last Name:KORRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1203 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-368-6414
Mailing Address - Fax:315-368-6444
Practice Address - Street 1:1203 HILTON AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501
Practice Address - Country:US
Practice Address - Phone:315-368-6414
Practice Address - Fax:315-368-6444
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker