Provider Demographics
NPI:1558495267
Name:REARDON, KAREN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BANK ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2806
Mailing Address - Country:US
Mailing Address - Phone:203-888-0462
Mailing Address - Fax:203-888-1465
Practice Address - Street 1:100 BANK ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2806
Practice Address - Country:US
Practice Address - Phone:203-888-0462
Practice Address - Fax:203-888-1465
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11738661OtherCAQH
CT549791OtherMANAGED HEALTH NETWORK-MHN/WELLMORE, INC.
CT004257334Medicaid