Healthcare Provider Details

I. General information

NPI: 1982937793
Provider Name (Legal Business Name): KAREN KOONCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 HANCOCK ST
BROOKLYN NY
11233-1205
US

IV. Provider business mailing address

746 HANCOCK ST
BROOKLYN NY
11233-1205
US

V. Phone/Fax

Practice location:
  • Phone: 917-805-4339
  • Fax:
Mailing address:
  • Phone: 917-805-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003771
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: