Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 078269 | NY |
N | 1041S0200X | School Social Worker | 078269 | NY |
NPI | 1003111733 |
---|---|
Provider Name | Ms. Susan Beth Koenig |
First Address | Bohemia, NY 11716-2614 |
Second Address | Bohemia, NY 11716-2614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2011 |
Last Update Date | 11/01/2011 |