Provider Demographics
NPI:1306911441
Name:KORETZ, E BARBARA (BCD, LCSW)
Entity type:Individual
Prefix:MS
First Name:E BARBARA
Middle Name:
Last Name:KORETZ
Suffix:
Gender:F
Credentials:BCD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17062 LISETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1436
Mailing Address - Country:US
Mailing Address - Phone:818-378-5732
Mailing Address - Fax:818-366-4947
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2302
Practice Address - Country:US
Practice Address - Phone:818-789-8351
Practice Address - Fax:818-789-8351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 124331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical