Provider Demographics
NPI:1538378245
Name:KORN, NAOMI SHARY (LCSW)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:SHARY
Last Name:KORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 CENTRAL AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3703
Mailing Address - Country:US
Mailing Address - Phone:727-894-6501
Mailing Address - Fax:727-821-6440
Practice Address - Street 1:535 CENTRAL AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3703
Practice Address - Country:US
Practice Address - Phone:727-894-6501
Practice Address - Fax:727-821-6440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1319Medicare ID - Type Unspecified