Provider Demographics
NPI:1144400912
Name:KORNBLUM, SHEILA JO (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:JO
Last Name:KORNBLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:JO
Other - Last Name:BECKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LMSW
Mailing Address - Street 1:609 SW 8TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7886
Mailing Address - Country:US
Mailing Address - Phone:479-418-1087
Mailing Address - Fax:
Practice Address - Street 1:609 SW 8TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7886
Practice Address - Country:US
Practice Address - Phone:479-418-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ARLCSW 2224-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker