Healthcare Provider Details

I. General information

NPI: 1174785208
Provider Name (Legal Business Name): CHRISTOPHER KONITZ LMHC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 KENSINGTON MNR
MIDDLETOWN NY
10941-1800
US

IV. Provider business mailing address

39 KENSINGTON MNR
MIDDLETOWN NY
10941-1800
US

V. Phone/Fax

Practice location:
  • Phone: 845-699-8110
  • Fax:
Mailing address:
  • Phone: 845-699-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000386
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6282531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: