Marissa Kornblau, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

118730 Issued in NY

Practice address

55 Taylor Rd
Mount Kisco, NY 10549-4504

Phone

(917) 208-0426

NPI assigned

Sep 6, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1013742063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 TAYLOR RD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105494504",
            "telephone_number": "917-208-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 TAYLOR RD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105494504",
            "telephone_number": "917-208-0426"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 Bedford Rd # 201C",
            "address_purpose": "LOCATION",
            "city": "Pleasantville",
            "state": "NY",
            "postal_code": "105703014",
            "country_code": "US",
            "telephone_number": "914-266-2584",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORNBLAU",
        "first_name": "MARISSA",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "118730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santhosh Koduri, MD
• Lewis Kohl, DO
• Sherry Koivunen, RNFA
• Bruce Kolkmann
• Steven Jay Konis, D.D.S.
• Eugene Kornhaber, MD
• Marla Koroly, MD
• Anu Koshy, NP
• Kotbi Psychiatry Services, PLLC
• Janice Krasilovsky

• Clinical Social Worker in Mount Kisco, NY
• Providers in Mount Kisco, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.