Provider Demographics
NPI:1316936818
Name:KONIEWICZ-EVERETT, SUSAN MARIE (MSW LCSWR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:KONIEWICZ-EVERETT
Suffix:
Gender:F
Credentials:MSW LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2323
Mailing Address - Country:US
Mailing Address - Phone:315-724-6702
Mailing Address - Fax:315-792-9294
Practice Address - Street 1:107 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2323
Practice Address - Country:US
Practice Address - Phone:315-724-6702
Practice Address - Fax:315-792-9294
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0247801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical