Provider Demographics
NPI:1740906296
Name:KERMASHEK, KOREN (LMSW)
Entity type:Individual
Prefix:
First Name:KOREN
Middle Name:
Last Name:KERMASHEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1071
Mailing Address - Country:US
Mailing Address - Phone:203-558-9448
Mailing Address - Fax:
Practice Address - Street 1:38 RIVERVIEW CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1071
Practice Address - Country:US
Practice Address - Phone:203-558-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker