Provider Demographics
NPI:1275901423
Name:KONOPINSKI, MARY THERESA (MSSA, LSW, LCDC-III)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESA
Last Name:KONOPINSKI
Suffix:
Gender:F
Credentials:MSSA, LSW, LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3899 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3844
Mailing Address - Country:US
Mailing Address - Phone:440-789-4703
Mailing Address - Fax:
Practice Address - Street 1:2675 E 30TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3000
Practice Address - Country:US
Practice Address - Phone:216-777-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151028101YA0400X
OHS1451383104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)