1922382696 NPI number — MS. ELIZABETH GRACE KORRIE LMSW

Table of content: MS. ELIZABETH GRACE KORRIE LMSW (NPI 1922382696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922382696 NPI number — MS. ELIZABETH GRACE KORRIE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORRIE
Provider First Name:
ELIZABETH
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KORRIE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922382696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 HILTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-368-6414
Provider Business Mailing Address Fax Number:
315-368-6444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 HILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-368-6414
Provider Business Practice Location Address Fax Number:
315-368-6444
Provider Enumeration Date:
09/29/2011

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: 104100000X , with the licence number:  050016 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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