Provider Demographics
NPI:1326392952
Name:KAREN B. FATTOROSI PHD LCSW LLC
Entity Type:Organization
Organization Name:KAREN B. FATTOROSI PHD LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FATTOROSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW
Authorized Official - Phone:352-854-5946
Mailing Address - Street 1:3309 SW 34TH CIR
Mailing Address - Street 2:104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3392
Mailing Address - Country:US
Mailing Address - Phone:352-854-5946
Mailing Address - Fax:352-854-0656
Practice Address - Street 1:3309 SW 34TH CIR
Practice Address - Street 2:104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3392
Practice Address - Country:US
Practice Address - Phone:352-854-5946
Practice Address - Fax:352-854-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 78711041C0700X
FLMT 2401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty