Provider Demographics
NPI:1578676607
Name:MABRY, KAREN DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:MABRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6922
Mailing Address - Country:US
Mailing Address - Phone:302-678-3652
Mailing Address - Fax:302-678-2545
Practice Address - Street 1:1095 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4141
Practice Address - Country:US
Practice Address - Phone:302-678-2000
Practice Address - Fax:302-346-0181
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE018403D21Medicare ID - Type Unspecified
DEQ58876Medicare UPIN