1306911441 NPI number — MS. E BARBARA KORETZ B.C.D., L.C.S.W.

Table of content: MS. E BARBARA KORETZ B.C.D., L.C.S.W. (NPI 1306911441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306911441 NPI number — MS. E BARBARA KORETZ B.C.D., L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORETZ
Provider First Name:
E BARBARA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
B.C.D., L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306911441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17062 LISETTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANADA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91344-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-378-5732
Provider Business Mailing Address Fax Number:
818-366-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16255 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-789-8351
Provider Business Practice Location Address Fax Number:
818-789-8351
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 12433 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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