Provider Demographics
NPI:1427168921
Name:KORCH, BRENDA JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:KORCH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LILLIAN WAY
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1136
Mailing Address - Country:US
Mailing Address - Phone:727-480-2427
Mailing Address - Fax:727-295-7133
Practice Address - Street 1:90 ROCKLAND ST STE 1
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2235
Practice Address - Country:US
Practice Address - Phone:727-480-2427
Practice Address - Fax:727-295-7133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FL133451041C0700X
MA1134871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical