Provider Demographics
NPI:1003288622
Name:GILLETTE, KAREN PATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:PATRICE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:HAWKINS
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3980 VANSTON RD
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1629
Mailing Address - Country:US
Mailing Address - Phone:631-734-5145
Mailing Address - Fax:
Practice Address - Street 1:3980 VANSTON RD
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1629
Practice Address - Country:US
Practice Address - Phone:908-303-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087548-11041C0700X
NY0881901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical