Provider Demographics
NPI:1871819136
Name:KORNEEVA, LUDMILA N (PHD, MS)
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:N
Last Name:KORNEEVA
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:LUDA
Other - Middle Name:
Other - Last Name:ORLOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1621 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4222
Mailing Address - Country:US
Mailing Address - Phone:925-939-8050
Mailing Address - Fax:
Practice Address - Street 1:1621 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4222
Practice Address - Country:US
Practice Address - Phone:925-939-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist