Provider Demographics
NPI:1700682416
Name:KORNGOLD PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:KORNGOLD PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-999-7535
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:415-999-7535
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty