Provider Demographics
NPI:1881737013
Name:KORN, AMY ROSE (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ROSE
Last Name:KORN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PATRI CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8320
Mailing Address - Country:US
Mailing Address - Phone:631-462-1159
Mailing Address - Fax:631-462-1159
Practice Address - Street 1:1120 OLD COUNTRY RD
Practice Address - Street 2:# 308
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5021
Practice Address - Country:US
Practice Address - Phone:631-499-0988
Practice Address - Fax:631-462-1159
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO62773-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical