Healthcare Provider Details

I. General information

NPI: 1205827722
Provider Name (Legal Business Name): MARGARET GRACE CORNISH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 LIGHTHOUSE AVE STE E
PACIFIC GROVE CA
93950-2565
US

IV. Provider business mailing address

PO BOX 187
MONTEREY CA
93942-0187
US

V. Phone/Fax

Practice location:
  • Phone: 831-601-4247
  • Fax: 831-417-0427
Mailing address:
  • Phone: 831-601-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: