| Stephen W. Koncsol P.a. | |
|
1011 Ives Dairy Rd Suite 208 Bldg. 2 North Miami Beach FL 33179-2536 | |
| (305) 653-0098 | |
| (305) 654-4412 |
| Full Name | Stephen W. Koncsol P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 1011 Ives Dairy Rd, North Miami Beach, Florida |
| Authorized Official Name and Position | Stephen W. Koncsol (PRESIDENT) |
| Authorized Official Contact | 3056530098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen W. Koncsol P.a. 1011 Ives Dairy Rd Suite 208 Bldg. 2 North Miami Beach FL 33179-2536 Ph: (305) 653-0098 | Stephen W. Koncsol P.a. 1011 Ives Dairy Rd Suite 208 Bldg. 2 North Miami Beach FL 33179-2536 Ph: (305) 653-0098 |
| NPI Number | 1174820534 |
|---|---|
| Provider Enumeration Date | 02/22/2011 |
| Last Update Date | 07/11/2011 |
| Medicare PECOS PAC ID | 0345419669 |
|---|---|
| Medicare Enrollment ID | O20110803000096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174820534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY0002754 (Florida) | Primary |
| Provider Name | Stephen W Koncsol |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780694349 PECOS PAC ID: 1153590476 Enrollment ID: I20110803000123 |
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