Provider Demographics
NPI:1174068522
Name:BERNSTORF, KATHRYN ELIZA KORENGOLD (LGSW)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN ELIZA
Middle Name:KORENGOLD
Last Name:BERNSTORF
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 KEEFER PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2515
Mailing Address - Country:US
Mailing Address - Phone:301-787-7557
Mailing Address - Fax:
Practice Address - Street 1:646 KEEFER PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2515
Practice Address - Country:US
Practice Address - Phone:301-787-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500811681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool