Provider Demographics
NPI:1053372326
Name:KORENBLATT, JEROME (LCSW)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:KORENBLATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2414
Mailing Address - Country:US
Mailing Address - Phone:914-629-5664
Mailing Address - Fax:
Practice Address - Street 1:495 FORT HILL RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2414
Practice Address - Country:US
Practice Address - Phone:914-629-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN39V41Medicare ID - Type Unspecified