Healthcare Provider Details

I. General information

NPI: 1043856529
Provider Name (Legal Business Name): KARLIN DHARIANA WALCOTT LMHC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 NORTH ST
MIDDLETOWN NY
10940-4704
US

IV. Provider business mailing address

305 NORTH ST
MIDDLETOWN NY
10940-4704
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-7675
  • Fax: 845-343-2501
Mailing address:
  • Phone: 845-343-7675
  • Fax: 845-343-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number006547
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: