Provider Demographics
NPI:1104963982
Name:KOROLCZUK, IRENE P (LCSW R)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:P
Last Name:KOROLCZUK
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:MRS
Other - First Name:IRENE
Other - Middle Name:P
Other - Last Name:KOROLCZUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:29 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-2312
Mailing Address - Country:US
Mailing Address - Phone:631-271-0913
Mailing Address - Fax:631-271-0914
Practice Address - Street 1:29 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-2312
Practice Address - Country:US
Practice Address - Phone:631-271-0913
Practice Address - Fax:631-261-3250
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO367951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical