Provider Demographics
NPI:1417590456
Name:BAACK, KAREN ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:BAACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454
Mailing Address - Country:US
Mailing Address - Phone:484-431-4962
Mailing Address - Fax:
Practice Address - Street 1:1489 BALTIMORE PIKE STE 250
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3974
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CW019990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health