Individual
JUSTIN CONRAD KOENITZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
220 BARTON BLVD, UNIT C14, ROCKLEDGE, FL 32955-2742
(321) 639-5177
(321) 639-4927
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8536
FL
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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