Provider Demographics
NPI:1114496825
Name:GOTTLIEB KORNFIELD, SARI (LCSW)
Entity Type:Individual
Prefix:
First Name:SARI
Middle Name:
Last Name:GOTTLIEB KORNFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOPE ROAD,
Mailing Address - Street 2:BLDG 3B, MAILBOX #8
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:732-724-1234
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE ROAD, BLDG 3B, MAILBOX #8
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-0772
Practice Address - Country:US
Practice Address - Phone:732-724-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058269001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical