Provider Demographics
NPI:1578946984
Name:PROSEN, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15301 COLEMAN VALLEY RD
Mailing Address - Street 2:BOHEMIAN HWY
Mailing Address - City:OCCIDENTAL
Mailing Address - State:CA
Mailing Address - Zip Code:95465-9373
Mailing Address - Country:US
Mailing Address - Phone:407-369-0114
Mailing Address - Fax:
Practice Address - Street 1:15301 COLEMAN VALLEY RD
Practice Address - Street 2:BOHEMIAN HWY
Practice Address - City:OCCIDENTAL
Practice Address - State:CA
Practice Address - Zip Code:95465-9373
Practice Address - Country:US
Practice Address - Phone:407-369-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist