Provider Demographics
NPI:1700046919
Name:KONCINSKY, DONNA (MS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KONCINSKY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NE 25TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4885
Mailing Address - Country:US
Mailing Address - Phone:352-671-7884
Mailing Address - Fax:
Practice Address - Street 1:1601 NE 25TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4885
Practice Address - Country:US
Practice Address - Phone:352-671-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766221100Medicaid