=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356579288
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ANN RECKMEYER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2009
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 S MAIN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-283-8224
-----------------------------------------------------
Fax | 860-283-6079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 258 S MAIN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06787-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-283-8224
-----------------------------------------------------
Fax | 860-283-6079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 002976
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------