Provider Demographics
NPI:1114538428
Name:KOENIG, SUSAN WISNHIP (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WISNHIP
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEADOWDAM RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3811
Mailing Address - Country:US
Mailing Address - Phone:781-424-8774
Mailing Address - Fax:781-424-8774
Practice Address - Street 1:10 MEADOWDAM RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3811
Practice Address - Country:US
Practice Address - Phone:781-424-8774
Practice Address - Fax:781-424-8774
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117726004104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker