Healthcare Provider Details

I. General information

NPI: 1861032120
Provider Name (Legal Business Name): KAREN C. FRAGETTA, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENILWORTH DR STE 100
TOWSON MD
21204-2142
US

IV. Provider business mailing address

1122 KENILWORTH DR STE 100
TOWSON MD
21204-2142
US

V. Phone/Fax

Practice location:
  • Phone: 410-881-2111
  • Fax: 410-881-2111
Mailing address:
  • Phone: 410-881-2111
  • Fax: 410-881-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN C FRAGETTA
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 410-881-2111