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General NPI Number Information
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NPI Number | 1275901423
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Entity Type | Individual
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Provider Name | MARY THERESA KONOPINSKI MSSA, LSW, LCDC-III
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 2675 E 30TH ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3000
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Country | US
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Telephone | 216-777-8139
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Fax |
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Provider Business Mailing Address
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Address Line | 3899 E 75TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-3844
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Country | US
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Telephone | 440-789-4703
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 151028
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S1451383
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License Number State | OH
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