Provider Demographics
NPI:1639296049
Name:DILLEY, KAREN JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JO
Last Name:DILLEY
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 1:41 CUSHMAN POINT RD
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4918
Mailing Address - Country:US
Mailing Address - Phone:207-882-6041
Mailing Address - Fax:
Practice Address - Street 1:1 LINCOLN ST STE 3
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2100
Practice Address - Country:US
Practice Address - Phone:207-720-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC41611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME326430099OtherMAINE CARE
ME326430099OtherMAINE CARE