Provider Demographics
NPI:1932687720
Name:KORS, STEPHANIE BROOKE (PHD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BROOKE
Last Name:KORS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4252
Mailing Address - Country:US
Mailing Address - Phone:443-475-0458
Mailing Address - Fax:
Practice Address - Street 1:408 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4252
Practice Address - Country:US
Practice Address - Phone:443-475-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07025103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical