Provider Demographics
NPI:1962423079
Name:SORNBERGER, KACEY HELEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KACEY
Middle Name:HELEN
Last Name:SORNBERGER
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 1:28 WITTE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4933
Mailing Address - Country:US
Mailing Address - Phone:617-417-2022
Mailing Address - Fax:
Practice Address - Street 1:401 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3854
Practice Address - Country:US
Practice Address - Phone:518-431-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775781041C0700X
MA1112911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1302272Medicaid