Provider Demographics
NPI:1144836081
Name:BLANCHARD GORE', KAREN MONICA (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MONICA
Last Name:BLANCHARD GORE'
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:MONICA
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:29 DUDLEY ST APT A
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-3162
Mailing Address - Country:US
Mailing Address - Phone:203-988-6409
Mailing Address - Fax:
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3042
Practice Address - Country:US
Practice Address - Phone:203-467-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty