Provider Demographics
NPI:1245095140
Name:KORNFELD, RITA
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:KORNFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N LINDEN DR STE 430
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2247
Mailing Address - Country:US
Mailing Address - Phone:310-487-9646
Mailing Address - Fax:310-274-1644
Practice Address - Street 1:462 N LINDEN DR STE 430
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2247
Practice Address - Country:US
Practice Address - Phone:310-487-9646
Practice Address - Fax:310-274-1644
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM14049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty