Provider Demographics
NPI:1356659692
Name:KONOPKA, ELZBIETA L
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:L
Last Name:KONOPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3131
Mailing Address - Country:US
Mailing Address - Phone:732-547-1751
Mailing Address - Fax:
Practice Address - Street 1:147 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3131
Practice Address - Country:US
Practice Address - Phone:732-547-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health