Provider Demographics
NPI:1376663591
Name:GOLDEN, KAREN LOUISE (EDD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 NEMACOLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1945
Mailing Address - Country:US
Mailing Address - Phone:301-724-7904
Mailing Address - Fax:301-777-3071
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1845
Practice Address - Country:US
Practice Address - Phone:301-777-0451
Practice Address - Fax:301-777-3071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02576103T00000X
WV576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1472860OtherCIGNA
MD52354901OtherBLUECROSS BLUESHIELD
MD1472860OtherCIGNA