Provider Demographics
NPI:1174820534
Name:STEPHEN W. KONCSOL P.A.
Entity Type:Organization
Organization Name:STEPHEN W. KONCSOL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KONCSOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-653-0098
Mailing Address - Street 1:1011 IVES DAIRY RD
Mailing Address - Street 2:SUITE 208 BLDG. 2
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2536
Mailing Address - Country:US
Mailing Address - Phone:305-653-0098
Mailing Address - Fax:305-654-4412
Practice Address - Street 1:1011 IVES DAIRY RD
Practice Address - Street 2:SUITE 208 BLDG. 2
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2536
Practice Address - Country:US
Practice Address - Phone:305-653-0098
Practice Address - Fax:305-654-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR04199Medicare UPIN