Provider Demographics
NPI:1831730704
Name:KORNBERG, REBECCA (MA, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KORNBERG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N BROAD ST APT B402
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-6706
Mailing Address - Country:US
Mailing Address - Phone:609-915-6645
Mailing Address - Fax:
Practice Address - Street 1:127 S 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1681
Practice Address - Country:US
Practice Address - Phone:609-915-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional