Provider Demographics
NPI:1497803548
Name:KONKEL, ROBERT EDWARD (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:KONKEL
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3679
Mailing Address - Country:US
Mailing Address - Phone:508-717-0212
Mailing Address - Fax:508-717-0212
Practice Address - Street 1:345 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3679
Practice Address - Country:US
Practice Address - Phone:508-717-0212
Practice Address - Fax:508-717-0212
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6254470OtherUBH
MAMBHPOther1853937
MA13266582OtherFIRST HEALTH
MAP06582OtherBCBS
MA000000028918OtherBMC HEALTHNET
MA1853937Medicaid
MA5350658OtherCCN
MA13266582OtherFIRST HEALTH
MAMBHPOther1853937
P06582Medicare ID - Type Unspecified