Provider Demographics
NPI:1033290341
Name:KOONS, CEDAR R (MSW)
Entity type:Individual
Prefix:MS
First Name:CEDAR
Middle Name:R
Last Name:KOONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MARQUEZ PL
Mailing Address - Street 2:211A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1834
Mailing Address - Country:US
Mailing Address - Phone:505-474-4480
Mailing Address - Fax:505-982-2196
Practice Address - Street 1:1012 MARQUEZ PL
Practice Address - Street 2:211A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1834
Practice Address - Country:US
Practice Address - Phone:505-474-4480
Practice Address - Fax:505-982-2196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-39251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical