Provider Demographics
NPI:1508905456
Name:HALL, KAREN IRENE (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:IRENE
Last Name:HALL
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 1:12625 HIGH BLUFF DR
Mailing Address - Street 2:114
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2052
Mailing Address - Country:US
Mailing Address - Phone:760-443-5425
Mailing Address - Fax:
Practice Address - Street 1:12625 HIGH BLUFF DR
Practice Address - Street 2:114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2052
Practice Address - Country:US
Practice Address - Phone:760-443-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical