Provider Demographics
NPI:1528475159
Name:KORDAK, NAOMI (LMSW-CC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:KORDAK
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3027
Mailing Address - Country:US
Mailing Address - Phone:140-678-1621
Mailing Address - Fax:
Practice Address - Street 1:283 ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3027
Practice Address - Country:US
Practice Address - Phone:140-678-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC140951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical