Provider Demographics
NPI:1699459651
Name:KORDENBROCK, MEGAN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:KORDENBROCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4115
Mailing Address - Country:US
Mailing Address - Phone:949-322-9737
Mailing Address - Fax:
Practice Address - Street 1:73 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4115
Practice Address - Country:US
Practice Address - Phone:347-465-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT141891041C0700X
NY0971671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical