Provider Demographics
NPI:1366869802
Name:SOUTHWORTH, KAREN ALICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ALICE
Last Name:SOUTHWORTH
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 1:4242 E WEST HWY
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5934
Mailing Address - Country:US
Mailing Address - Phone:301-986-8499
Mailing Address - Fax:
Practice Address - Street 1:4242 E WEST HWY
Practice Address - Street 2:SUITE 1109
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5934
Practice Address - Country:US
Practice Address - Phone:301-986-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical