Provider Demographics
NPI:1639111354
Name:KORMAN, NINA MELANIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:MELANIE
Last Name:KORMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:NICKI
Other - Middle Name:MELANIE
Other - Last Name:KORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1353 BOSTON POST RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3445
Mailing Address - Country:US
Mailing Address - Phone:203-245-4219
Mailing Address - Fax:860-669-3145
Practice Address - Street 1:1353 BOSTON POST RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3445
Practice Address - Country:US
Practice Address - Phone:203-245-4219
Practice Address - Fax:860-669-3145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist