Susan Wisnhip Koenig, LICSW

Individual provider Active NPI Social Worker · Lincoln, MA

NPI 1114538428 · NPPES record last updated Aug 11, 2020

Key facts

NPI
1114538428
Entity type
Individual (NPI type 1)
Primary specialty
Social Worker 104100000X
License
117726004 (MA)
Practice address
10 Meadowdam Rd
Lincoln, MA 01773-3811
Phone
(781) 424-8774
Fax
(781) 424-8774
NPI assigned
Aug 11, 2020
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
117726004MAMDSocial Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 117726004 MA Yes

Addresses

Primary practice location

10 Meadowdam Rd
Lincoln, MA 01773-3811

Mailing address

10 Meadowdam Rd
Lincoln, MA 01773-3811
Phone (781) 424-8774

Other providers in Lincoln, MA

All providers in Lincoln, MA · Social Worker in Massachusetts

Sources for this page

Verify at the official NPI Registry.