Provider Demographics
NPI:1598061392
Name:CHIMENTO, KAREN L (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:CHIMENTO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 THE COMMONS
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5551
Mailing Address - Country:US
Mailing Address - Phone:607-273-1508
Mailing Address - Fax:607-273-8326
Practice Address - Street 1:202 THE COMMONS
Practice Address - Street 2:SUITE 412
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5551
Practice Address - Country:US
Practice Address - Phone:607-273-1508
Practice Address - Fax:607-273-8326
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0726171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical