Provider Demographics
NPI:1790859049
Name:KOERNER, DOROTHY L (LICSW, MSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CONCORD SQ
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3101
Mailing Address - Country:US
Mailing Address - Phone:617-738-7668
Mailing Address - Fax:617-353-1761
Practice Address - Street 1:41 CONCORD SQ
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3101
Practice Address - Country:US
Practice Address - Phone:617-738-7668
Practice Address - Fax:617-353-1761
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1035881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical