=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225278476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ELIZABETH FALLON PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2009
-----------------------------------------------------
Last Update Date | 10/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 WASECA AVE
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-3562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-245-4040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 MAPLE RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02885-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-982-4395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS01107
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 8959
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------