Provider Demographics
NPI:1225156540
Name:KONIGSBERG, ANNE (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:KONIGSBERG
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 E 2ND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3946
Mailing Address - Country:US
Mailing Address - Phone:562-434-2373
Mailing Address - Fax:
Practice Address - Street 1:5580 E 2ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3946
Practice Address - Country:US
Practice Address - Phone:562-434-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR37412Medicare UPIN