Provider Demographics
NPI:1932656204
Name:KOREN, MICHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOREN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 LINCOLN ST
Mailing Address - Street 2:UMMMC, HAHNEMANN FAMILY HEALTH CENTER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2120
Mailing Address - Country:US
Mailing Address - Phone:508-334-2818
Mailing Address - Fax:508-334-8810
Practice Address - Street 1:279 LINCOLN ST
Practice Address - Street 2:UMMMC, HAHNEMANN FAMILY HEALTH CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2120
Practice Address - Country:US
Practice Address - Phone:508-334-2818
Practice Address - Fax:508-334-8810
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA10867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program