Healthcare Provider Details

I. General information

NPI: 1972013415
Provider Name (Legal Business Name): KAREN SMITH LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 NAUGATUCK AVE
MILFORD CT
06461-4059
US

IV. Provider business mailing address

16 WESTMINSTER CT
MILFORD CT
06461-1619
US

V. Phone/Fax

Practice location:
  • Phone: 475-331-2100
  • Fax: 203-283-7714
Mailing address:
  • Phone: 475-331-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number008381
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number008381
License Number StateCT

VIII. Authorized Official

Name: KAREN MADELEINE SMITH
Title or Position: OWNER
Credential: LCSW
Phone: 475-331-2100