Provider Demographics
NPI:1669778254
Name:KORNFELD, MARYLYDE (LIMHP)
Entity type:Individual
Prefix:
First Name:MARYLYDE
Middle Name:
Last Name:KORNFELD
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1508
Mailing Address - Country:US
Mailing Address - Phone:402-441-6653
Mailing Address - Fax:402-441-8152
Practice Address - Street 1:2966 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1508
Practice Address - Country:US
Practice Address - Phone:402-441-6653
Practice Address - Fax:402-441-8152
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health