Provider Demographics
NPI:1346531803
Name:WALSH, KAREN A (LPC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:MALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:515 CENTERPOINT DR STE 801
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7570
Mailing Address - Country:US
Mailing Address - Phone:860-716-4694
Mailing Address - Fax:855-386-7000
Practice Address - Street 1:1224 MILL ST BLDG B
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1159
Practice Address - Country:US
Practice Address - Phone:860-716-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2418OtherCONNECT DEPARTMENT OF PUBLIC HEALTH