Provider Demographics
NPI:1902975048
Name:KORNBLUTH, CHRISTINE D (LCSW, ACSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:D
Last Name:KORNBLUTH
Suffix:
Gender:F
Credentials:LCSW, ACSW, MSW
Other - Prefix:MRS
Other - First Name:CHRIS
Other - Middle Name:D
Other - Last Name:KLOFKORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, ACSW, MSW
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:
Practice Address - Street 1:1800 COMMUNITY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-8804
Practice Address - Country:US
Practice Address - Phone:888-403-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0046951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497752204Medicaid
MO497752246Medicaid
10001133600OtherCOMMUNITY HEALTH PLAN
27108011OtherBLUE CROSS BLUE SHIELD