MEDICARE: MS. JULIE KONIGSBERG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW0265	AZ

General Provider Information

NPI Number	:	1093710006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE KONIGSBERG LCSW

Provider Business Mailing Address
First Line	:	4375 N VENTANA LOOP
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6227
Country	:	US
Telephone Number	:	520-722-0190
Fax Number	:	520-885-9013

Provider Business Practice Location Address
First Line	:	5956 E PIMA ST
Second Line	:	STE 130
City	:	TUCSON
State	:	AZ
Zip	:	85712-4384
Country	:	US
Telephone Number	:	520-722-0190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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