Provider Demographics
NPI:1982647087
Name:KOENIGSBERG, REBECCA KRAMER (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KRAMER
Last Name:KOENIGSBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YALE NEW HAVEN HOSPITAL
Mailing Address - Street 2:20 YORK STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06504
Mailing Address - Country:US
Mailing Address - Phone:203-688-9743
Mailing Address - Fax:203-688-3569
Practice Address - Street 1:YALE-NEW HAVEN HOSPITAL
Practice Address - Street 2:20 YORK STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-688-9743
Practice Address - Fax:203-389-3596
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000568101YA0400X
CT0034241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003264Medicare ID - Type Unspecified