Provider Demographics
NPI:1356399141
Name:KORALEWSKI, MARY (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KORALEWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BAY AREA BLVD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4043
Mailing Address - Country:US
Mailing Address - Phone:713-906-4784
Mailing Address - Fax:281-240-6481
Practice Address - Street 1:711 W BAY AREA BLVD
Practice Address - Street 2:SUITE 126
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4043
Practice Address - Country:US
Practice Address - Phone:713-906-4784
Practice Address - Fax:281-240-6481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103T00000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016CMOtherBC/BS
TX0016CMOtherBC/BS