Provider Demographics
NPI:1023200854
Name:HALEY, KAREN (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04938-3314
Mailing Address - Country:US
Mailing Address - Phone:207-491-3784
Mailing Address - Fax:
Practice Address - Street 1:32 MAIN ST
Practice Address - Street 2:OFFICE #1
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1244
Practice Address - Country:US
Practice Address - Phone:207-491-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC3386101YA0400X
MEMC10610104100000X
MELC117041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC11704OtherLICENSE
ME432634199Medicaid