Provider Demographics
NPI:1255466314
Name:GIESEKE, KAREN JOHNSTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOHNSTON
Last Name:GIESEKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3257
Mailing Address - Country:US
Mailing Address - Phone:401-846-4662
Mailing Address - Fax:401-842-0009
Practice Address - Street 1:42 SPRING ST
Practice Address - Street 2:SUITE 13
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2979
Practice Address - Country:US
Practice Address - Phone:401-842-0009
Practice Address - Fax:401-842-0059
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00513103T00000X
MA6732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist