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NPI Code Detail

MEDICARE: DOUGLAS KOENIG LCSW

MEDICARE: DOUGLAS KOENIG 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
1104100000XSocial Worker33012367AIN
21041C0700XClinical Social Worker149.031096IL

General Provider Information

NPI Number : 1447063631
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS KOENIG LCSW
Provider Business Mailing Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-2780
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-2780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2025
Last Update Date : 02/04/2026

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Directions to “ DOUGLAS KOENIG LCSW” Practice Location

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