MEDICARE: JOANNE KONECKY 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	104100000X	Social Worker	034002-1	NY
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	088654	NY

General Provider Information

NPI Number	:	1881953719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE KONECKY LCSW

Provider Business Mailing Address
First Line	:	49 RED GROUND RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1710
Country	:	US
Telephone Number	:	516-978-9197
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 RED GROUND RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1710
Country	:	US
Telephone Number	:	516-978-9197
Fax Number	:

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

Provider Enumeration Date	:	05/12/2012
Last Update Date	:	09/08/2019

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