MEDICARE: MARCIE KOENIG LCSW-C

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	09590	MD

General Provider Information

NPI Number	:	1174261663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE KOENIG LCSW-C

Provider Business Mailing Address
First Line	:	12138 PATAPSCO RIDGE RD
Second Line	:
City	:	MARRIOTTSVILLE
State	:	MD
Zip	:	21104-1424
Country	:	US
Telephone Number	:	443-756-8645
Fax Number	:

Provider Business Practice Location Address
First Line	:	8850 COLUMBIA 100 PKWY STE 203
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2376
Country	:	US
Telephone Number	:	443-546-4476
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	05/24/2022

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