Provider Demographics
NPI:1740477249
Name:KONECNY, BROOKE E (MSW)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:E
Last Name:KONECNY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2116
Mailing Address - Country:US
Mailing Address - Phone:617-523-1529
Mailing Address - Fax:617-523-1207
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-523-1529
Practice Address - Fax:617-523-1207
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker