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General NPI Number Information
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NPI Number | 1154639557
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Entity Type | Individual
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Provider Name | ADRIENNE KOENIGSBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 1450 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4405
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Country | US
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Telephone | 203-789-4039
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Fax | 203-867-5213
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Provider Business Mailing Address
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Address Line | 103 N HUMISTON DR
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City | BETHANY
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State | CT
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Zip | 06524-3119
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Country | US
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Telephone | 203-313-3217
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7339
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License Number State | CT
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