Provider Demographics
NPI:1376730002
Name:KORNGOLD, BEAR (PSYD)
Entity type:Individual
Prefix:DR
First Name:BEAR
Middle Name:
Last Name:KORNGOLD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MIRABEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4614
Mailing Address - Country:US
Mailing Address - Phone:415-738-8055
Mailing Address - Fax:415-590-7250
Practice Address - Street 1:1201 NOE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3713
Practice Address - Country:US
Practice Address - Phone:415-738-8055
Practice Address - Fax:415-590-7250
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical