Provider Demographics
NPI:1427003615
Name:EARNEST, KAREN DERECHO (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DERECHO
Last Name:EARNEST
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 1:122A E. FOOTHILL BLVD.
Mailing Address - Street 2:# 217
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2505
Mailing Address - Country:US
Mailing Address - Phone:626-975-7635
Mailing Address - Fax:
Practice Address - Street 1:444 E HUNTINGTON DR STE 333
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6257
Practice Address - Country:US
Practice Address - Phone:626-975-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11719Medicare ID - Type Unspecified