Provider Demographics
NPI:1346449675
Name:KORNFELD, SHOSHANA (PHD)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:KORNFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:RAIBER-KORNFELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1420 WILLOW PASS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5823
Mailing Address - Country:US
Mailing Address - Phone:925-521-5115
Mailing Address - Fax:925-646-5754
Practice Address - Street 1:1420 WILLOW PASS RD STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5823
Practice Address - Country:US
Practice Address - Phone:925-521-5115
Practice Address - Fax:925-646-5754
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical