Provider Demographics
NPI:1710537758
Name:SEELERT, KAREN ROTHBALLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ROTHBALLER
Last Name:SEELERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:ROTHBALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 OLD KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4732
Mailing Address - Country:US
Mailing Address - Phone:203-202-7654
Mailing Address - Fax:
Practice Address - Street 1:85 OLD KINGS HWY N
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4732
Practice Address - Country:US
Practice Address - Phone:203-202-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CT3871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist