Provider Demographics
NPI:1063863868
Name:MARY ELIZABETH KARLAN
Entity Type:Organization
Organization Name:MARY ELIZABETH KARLAN
Other - Org Name:MK PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-570-6047
Mailing Address - Street 1:7 KEOFFERAM ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870
Mailing Address - Country:US
Mailing Address - Phone:858-255-1369
Mailing Address - Fax:
Practice Address - Street 1:7 KEOFFERAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-2112
Practice Address - Country:US
Practice Address - Phone:858-255-1369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty