Provider Demographics
NPI:1609823616
Name:KORETSKY, PAMELA H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:H
Last Name:KORETSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:KORETSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:235 NE 1ST ST APT 401
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3784
Mailing Address - Country:US
Mailing Address - Phone:919-605-3544
Mailing Address - Fax:888-972-8449
Practice Address - Street 1:8480 HONEYCUTT RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2261
Practice Address - Country:US
Practice Address - Phone:919-605-3544
Practice Address - Fax:888-972-8449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25061041C0700X
NCCOO28801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002041Medicaid
NC1101KOtherBCBS OF NC PROVIDER NUMBE
NC2869277Medicare ID - Type Unspecified