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General NPI Number Information
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NPI Number | 1720660822
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Entity Type | Individual
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Provider Name | RACHEL M KORNMANN MA, LAC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 981 ROUTE 22
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2946
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Country | US
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Telephone | 856-436-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 88 JACKSON AVE APT 119
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City | EDISON
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State | NJ
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Zip | 08837-3165
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Country | US
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Telephone | 732-850-8152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37AC00576800
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License Number State | NJ
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