Provider Demographics
NPI:1275226326
Name:CORNELL & ASSOCIATES MARRIAGE AND FAMILY THERAPY
Entity Type:Organization
Organization Name:CORNELL & ASSOCIATES MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:917-225-1401
Mailing Address - Street 1:7770 REGENTS RD # 113-546
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1937
Mailing Address - Country:US
Mailing Address - Phone:917-225-1401
Mailing Address - Fax:
Practice Address - Street 1:7770 REGENTS RD # 113-546
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1937
Practice Address - Country:US
Practice Address - Phone:917-225-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty