Provider Demographics
NPI:1093902579
Name:WIMBERLY, KAREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BAKERJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3 SPRING MDW
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07863-3246
Mailing Address - Country:US
Mailing Address - Phone:908-453-3334
Mailing Address - Fax:
Practice Address - Street 1:651 WILLOW GROVE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1799
Practice Address - Country:US
Practice Address - Phone:908-850-6812
Practice Address - Fax:908-850-6846
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005838001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0380661Medicaid
NJ820780Medicare PIN