Provider Demographics
NPI:1720660822
Name:KORNMANN, RACHEL M (MA, LAC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:KORNMANN
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 JACKSON AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3165
Mailing Address - Country:US
Mailing Address - Phone:732-850-8152
Mailing Address - Fax:
Practice Address - Street 1:981 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2946
Practice Address - Country:US
Practice Address - Phone:856-436-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00576800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)