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Individual

NANCY CAROL KORNGOLD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMHC

Contact information

Practice address
178 OAKVILLE ST, STATEN ISLAND, NY 10314-5053
(917) 502-1962
Mailing address
178 OAKVILLE ST, STATEN ISLAND, NY 10314-5053
(718) 983-8193

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CERT #11727
NY
101YM0800X
Mental Health Counselor
002505-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
UNKNOWN
MAGELAN BEHAVIORAL HEALTH
NY
Enumeration date
03/04/2009
Last updated
02/22/2016
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