Provider Demographics
NPI:1497004949
Name:LITTLE-BENNETT, KAREN L (LCADC, CCS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:LITTLE-BENNETT
Suffix:
Gender:F
Credentials:LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1109
Mailing Address - Country:US
Mailing Address - Phone:973-223-2382
Mailing Address - Fax:
Practice Address - Street 1:857 S 19TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1109
Practice Address - Country:US
Practice Address - Phone:973-223-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00151000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)