Provider Demographics
NPI:1184978249
Name:KORBA, ANNA FOSTER (MA AT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:FOSTER
Last Name:KORBA
Suffix:
Gender:F
Credentials:MA AT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:FOSTER
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA AT
Mailing Address - Street 1:204 WILLS RD
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-4229
Mailing Address - Country:US
Mailing Address - Phone:724-322-1240
Mailing Address - Fax:
Practice Address - Street 1:416 S PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-4003
Practice Address - Country:US
Practice Address - Phone:724-626-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
PAPC007193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist