=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326392952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN B. FATTOROSI PHD LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2012
-----------------------------------------------------
Last Update Date | 11/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3309 SW 34TH CIR 104
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-3392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-854-5946
-----------------------------------------------------
Fax | 352-854-0656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3309 SW 34TH CIR 104
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-3392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-854-5946
-----------------------------------------------------
Fax | 352-854-0656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KAREN B FATTOROSI
-----------------------------------------------------
Credential | PHD LCSW
-----------------------------------------------------
Telephone | 352-854-5946
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT 2401
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 7871
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------