Provider Demographics
NPI:1780627497
Name:KORENKIEWICZ, JUDY (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:KORENKIEWICZ
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5268
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-5268
Mailing Address - Country:US
Mailing Address - Phone:252-354-4901
Mailing Address - Fax:
Practice Address - Street 1:215 N 35TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-0602
Practice Address - Country:US
Practice Address - Phone:252-726-1098
Practice Address - Fax:252-247-6622
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184GOtherBCBSNC
NC6002570Medicaid
NC2868644Medicare ID - Type Unspecified