Healthcare Provider Details

I. General information

NPI: 1447136890
Provider Name (Legal Business Name): KARMY MARA LUKER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date: 06/02/2026
Reactivation Date: 07/20/2026

III. Provider practice location address

418 WILLOW ST
FARIBAULT MN
55021-6247
US

IV. Provider business mailing address

418 WILLOW ST
FARIBAULT MN
55021-6247
US

V. Phone/Fax

Practice location:
  • Phone: 952-873-9935
  • Fax:
Mailing address:
  • Phone: 651-358-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31618
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: