Healthcare Provider Details

I. General information

NPI: 1497727820
Provider Name (Legal Business Name): KAREN ANN DESOCIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95TH MEDICAL GROUP/SGOHF 30 NIGHTINGALE RD
EDWARDS AFB CA
93524-0001
US

IV. Provider business mailing address

43466 GADSDEN AVE APARTMENT 194
LANCASTER CA
93534-6165
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5292
  • Fax:
Mailing address:
  • Phone: 661-277-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 18451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: