Healthcare Provider Details

I. General information

NPI: 1669991709
Provider Name (Legal Business Name): RICHARD KEVIN KOENIG PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2017
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 KEY BLVD
EL CERRITO CA
94530-1735
US

IV. Provider business mailing address

1918 UNIVERSITY AVE STE 2B
BERKELEY CA
94704-3264
US

V. Phone/Fax

Practice location:
  • Phone: 510-730-2031
  • Fax:
Mailing address:
  • Phone: 510-548-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY35544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: