Provider Demographics
NPI:1952654832
Name:KORNFELD, MATTHEW PB (CAADC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PB
Last Name:KORNFELD
Suffix:
Gender:M
Credentials:CAADC
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Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-889-0732
Practice Address - Street 1:9815 ROOSEVELT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1011
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-889-0732
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)