Provider Demographics
NPI:1609092097
Name:DAVERN, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DAVERN
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 1:1555 SUNRISE HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6027
Mailing Address - Country:US
Mailing Address - Phone:631-666-1615
Mailing Address - Fax:631-666-1709
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:631-666-1615
Practice Address - Fax:631-666-1709
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical