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General NPI Number Information
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NPI Number | 1063733459
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Entity Type | Individual
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Provider Name | ANGELA L KONIN LSW
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Gender | Female
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Dates
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Enumeration Date | 06/20/2010
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 245C NASSAU ST
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City | PRINCETON
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State | NJ
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Zip | 08540-4619
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Country | US
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Telephone | 609-477-0401
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Fax |
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Provider Business Mailing Address
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Address Line | C7 CARVER PL
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-1419
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Country | US
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Telephone | 609-477-0401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18KT01360200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL06789100
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License Number State | NJ
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