Provider Demographics
NPI:1568948685
Name:KORNBLUTH, MEGAN AIMEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:AIMEE
Last Name:KORNBLUTH
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 1:15473 ARCHERY VW
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1415
Mailing Address - Country:US
Mailing Address - Phone:530-580-8848
Mailing Address - Fax:
Practice Address - Street 1:1201 TERMINAL WAY
Practice Address - Street 2:STE 202
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3395
Practice Address - Country:US
Practice Address - Phone:530-580-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7983-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical