Provider Demographics
NPI:1962121566
Name:KORNACKI, MATTHEW (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:KORNACKI
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:E PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1159
Mailing Address - Country:US
Mailing Address - Phone:847-736-0345
Mailing Address - Fax:
Practice Address - Street 1:825 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4713
Practice Address - Country:US
Practice Address - Phone:717-462-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health