Provider Demographics
NPI:1528393709
Name:WORRELL, KARIN JO (PHD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:JO
Last Name:WORRELL
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44482-0212
Mailing Address - Country:US
Mailing Address - Phone:330-469-6879
Mailing Address - Fax:234-600-5046
Practice Address - Street 1:2460 ELM RD NE STE 900
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2955
Practice Address - Country:US
Practice Address - Phone:330-469-6879
Practice Address - Fax:234-600-5046
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157639Medicaid