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General NPI Number Information
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NPI Number | 1003824012
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Entity Type | Individual
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Provider Name | KAREN A ETHIER-WARING LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 591 POQUONNOCK ROAD CHILD & FAMILY AGENCY
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City | GROTON
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State | CT
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Zip | 06340
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Country | US
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Telephone | 860-449-8217
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Fax | 860-449-8323
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Provider Business Mailing Address
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Address Line | 306 PACKER RD
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City | MYSTIC
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State | CT
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Zip | 06355
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Country | US
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Telephone | 860-536-7495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000706
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License Number State | CT
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