MEDICARE: MR. SCOTT ROBERT KOENIGSBERG LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701003223	VA

General Provider Information

NPI Number	:	1275868002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ROBERT KOENIGSBERG LPC

Provider Business Mailing Address
First Line	:	3921 OLD LEE HWY
Second Line	:	SUITE 73B
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-636-2888
Fax Number	:	703-991-9161

Provider Business Practice Location Address
First Line	:	3921 OLD LEE HWY
Second Line	:	SUITE 73B
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-636-2888
Fax Number	:	703-991-9161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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