Provider Demographics
NPI:1962741132
Name:KORN, WILLIAM MARK (LCSW, MSW, MED)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:KORN
Suffix:
Gender:M
Credentials:LCSW, MSW, MED
Other - Prefix:
Other - First Name:ZE'EV
Other - Middle Name:
Other - Last Name:KORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MSW, MED
Mailing Address - Street 1:3501 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3237
Mailing Address - Country:US
Mailing Address - Phone:323-730-1205
Mailing Address - Fax:
Practice Address - Street 1:3501 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3237
Practice Address - Country:US
Practice Address - Phone:323-730-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS288681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical