Provider Demographics
NPI:1649594375
Name:BROGAN, KAREN LAINE (MA, LCSW-R)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:LAINE
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MA, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BRENTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2226
Mailing Address - Country:US
Mailing Address - Phone:585-216-5213
Mailing Address - Fax:
Practice Address - Street 1:1732 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-461-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0556391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical