Provider Demographics
NPI:1073654505
Name:SOLOMON, KAREN A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MADDER LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2341
Mailing Address - Country:US
Mailing Address - Phone:631-543-2050
Mailing Address - Fax:631-543-2051
Practice Address - Street 1:43 MADDER LAKE CIR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2341
Practice Address - Country:US
Practice Address - Phone:631-543-2050
Practice Address - Fax:631-543-2051
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN79351Medicare ID - Type UnspecifiedMEDICARE PROVIDER #