Provider Demographics
NPI:1700825650
Name:CHISHOLM, KARLENE (LMFT)
Entity Type:Individual
Prefix:
First Name:KARLENE
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4721
Mailing Address - Country:US
Mailing Address - Phone:203-925-7727
Mailing Address - Fax:203-925-7727
Practice Address - Street 1:4 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-925-7727
Practice Address - Fax:203-925-7727
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist