Provider Demographics
NPI:1780008318
Name:KORNFELD-JACOBS, GILA (PHD)
Entity Type:Individual
Prefix:
First Name:GILA
Middle Name:
Last Name:KORNFELD-JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BUSWELL PARK
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2304
Mailing Address - Country:US
Mailing Address - Phone:617-244-9840
Mailing Address - Fax:508-695-0345
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-660-6699
Practice Address - Fax:508-695-0345
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical