Provider Demographics
NPI:1164546495
Name:MARODA, KAREN JEAN (PHD, ABBP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JEAN
Last Name:MARODA
Suffix:
Gender:F
Credentials:PHD, ABBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N JEFFERSON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3721
Mailing Address - Country:US
Mailing Address - Phone:414-276-9760
Mailing Address - Fax:
Practice Address - Street 1:825 N JEFFERSON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3721
Practice Address - Country:US
Practice Address - Phone:414-276-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist