Provider Demographics
NPI:1487704938
Name:KOENIG, VIRGINIA C
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:KOENIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 FREEPORT RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3110
Mailing Address - Country:US
Mailing Address - Phone:412-963-9360
Mailing Address - Fax:
Practice Address - Street 1:1376 FREEPORT RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3110
Practice Address - Country:US
Practice Address - Phone:412-963-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007843L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist