=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497004949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN L LITTLE-BENNETT LCADC, CCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2012
-----------------------------------------------------
Last Update Date | 08/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 857 S 19TH ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07108-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-223-2382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 857 S 19TH ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07108-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-223-2382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 37LC00151000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------