Provider Demographics
NPI:1891710117
Name:KORNFIELD-PREMISLER, BERNICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:
Last Name:KORNFIELD-PREMISLER
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 1:764 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1231
Mailing Address - Country:US
Mailing Address - Phone:631-751-0196
Mailing Address - Fax:631-689-9741
Practice Address - Street 1:3 TALLMADGE GATE
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1417
Practice Address - Country:US
Practice Address - Phone:631-751-0196
Practice Address - Fax:631-689-9741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0310961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN46171Medicare ID - Type Unspecified