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General NPI Number Information
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NPI Number | 1063863868
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Entity Type | Organization
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Legal Business Name | MARY ELIZABETH KARLAN
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 7 KEOFFERAM RD SUITE B
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City | OLD GREENWICH
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State | CT
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Zip | 06870-2112
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Country | US
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Telephone | 858-255-1369
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Fax |
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Provider Business Mailing Address
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Address Line | 7 KEOFFERAM ROAD SUITE B
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City | OLD GREENWICH
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State | CT
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Zip | 06870
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Country | US
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Telephone | 858-255-1369
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MARY ELIZABETH KARLAN
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Credential | LCSW
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Telephone | 203-570-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009248
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License Number State | CT
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