Provider Demographics
NPI:1366535197
Name:KONOPKA, WOJCIECH JAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:WOJCIECH
Middle Name:JAN
Last Name:KONOPKA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1333
Mailing Address - Country:US
Mailing Address - Phone:315-493-4180
Mailing Address - Fax:315-493-4188
Practice Address - Street 1:3 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1333
Practice Address - Country:US
Practice Address - Phone:315-493-4180
Practice Address - Fax:315-493-4188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-0679661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical