Provider Demographics
NPI:1861728487
Name:KOENIG, SCOTT D (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:KOENIG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 HOLIDAY CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0026
Mailing Address - Country:US
Mailing Address - Phone:858-442-7927
Mailing Address - Fax:858-450-1161
Practice Address - Street 1:3262 HOLIDAY CT
Practice Address - Street 2:SUITE 220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0026
Practice Address - Country:US
Practice Address - Phone:858-442-7927
Practice Address - Fax:858-450-1161
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical