Provider Demographics
NPI:1073677464
Name:CORNFORTH, EMILY JUNG (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JUNG
Last Name:CORNFORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JUNG
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04978-0220
Mailing Address - Country:US
Mailing Address - Phone:207-362-5252
Mailing Address - Fax:207-362-5229
Practice Address - Street 1:189 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04978-3403
Practice Address - Country:US
Practice Address - Phone:207-362-5252
Practice Address - Fax:207-362-5229
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker