Healthcare Provider Details

I. General information

NPI: 1700830346
Provider Name (Legal Business Name): KAREN M DAGUE LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN M YACANO

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/20/2024
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COURT STREET STE 42
NORWICH NY
13815
US

IV. Provider business mailing address

5 COURT STREET STE 42
NORWICH NY
13815
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-1600
  • Fax: 607-334-4519
Mailing address:
  • Phone: 607-337-1600
  • Fax: 607-334-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR049829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: