Healthcare Provider Details

I. General information

NPI: 1326392952
Provider Name (Legal Business Name): KAREN B. FATTOROSI PHD LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SW 34TH CIR 104
OCALA FL
34474-3392
US

IV. Provider business mailing address

3309 SW 34TH CIR 104
OCALA FL
34474-3392
US

V. Phone/Fax

Practice location:
  • Phone: 352-854-5946
  • Fax: 352-854-0656
Mailing address:
  • Phone: 352-854-5946
  • Fax: 352-854-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 7871
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2401
License Number StateFL

VIII. Authorized Official

Name: DR. KAREN B FATTOROSI
Title or Position: OWNER
Credential: PHD LCSW
Phone: 352-854-5946