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NPI Code Detail

MEDICARE: MARCY KOONCE SW25664

MEDICARE:   MARCY  KOONCE  SW25664
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
11041C0700XClinical Social WorkerSW25664FL

General Provider Information

NPI Number : 1912504523
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCY KOONCE SW25664
Provider Business Mailing Address
First Line : 8408 WINTER GARDEN PKWY
Second Line :
City : FORT PIERCE
State : FL
Zip : 34951-1394
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8408 WINTER GARDEN PKWY
Second Line :
City : FORT PIERCE
State : FL
Zip : 34951-1394
Country : US
Telephone Number : 772-242-3515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2020
Last Update Date : 04/16/2026

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