Provider Demographics
NPI:1215435508
Name:KORNITZER, TAMAR (LMSW)
Entity type:Individual
Prefix:MS
First Name:TAMAR
Middle Name:
Last Name:KORNITZER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CLOWES TER
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1605
Mailing Address - Country:US
Mailing Address - Phone:203-510-7537
Mailing Address - Fax:
Practice Address - Street 1:556 SHOEMAKER RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2435
Practice Address - Country:US
Practice Address - Phone:203-510-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4133104100000X
NY0973001041C0700X
PACW0242071041C0700X
CT58.0112611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker