Provider Demographics
NPI:1881796506
Name:KOROL, MINDY
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:
Last Name:KOROL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4410
Mailing Address - Country:US
Mailing Address - Phone:301-471-1705
Mailing Address - Fax:301-695-8842
Practice Address - Street 1:176 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4410
Practice Address - Country:US
Practice Address - Phone:301-471-1705
Practice Address - Fax:301-695-8842
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD443SMedicare ID - Type Unspecified