Healthcare Provider Details

I. General information

NPI: 1801495833
Provider Name (Legal Business Name): KAREN MARIE CODD FAIRCHILD MPS, LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN MARIE CODD MPS, LCAT, ATR-BC

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 VAN WYCK EXPY
RICHMOND HILL NY
11418-2897
US

IV. Provider business mailing address

364 S 1ST ST APT 20
BROOKLYN NY
11211-4725
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-7160
  • Fax:
Mailing address:
  • Phone: 917-256-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001953
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: