| Doctor Name: | DR. JESSICA KORNWASSER |
| NPI Number: | 1043458862 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 4632 |
| Business Practice Address: | 1 Prospect St Suite 5-7 Ridgewood, NJ - 074504404 |
| Business Phone Number: | 2014472242 |
| Business Fax Number: | 2014474377 |
| Mailing Address: | 1 Prospect St, Suite 5-7 RIDGEWOOD |
| State: | NJ |
| Postal Code: | 074504404 |
| Phone Number: | 2014472242 |
| Fax Number: | 2014474377 |
| NPI Enumeration Date: | 02/02/2009 |
| NPI Last Update Date: | 02/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 4632 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |