Provider Demographics
NPI:1770831265
Name:ANNIS, KAREN LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:ANNIS
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 1:19 HILLSIDE LANE
Mailing Address - Street 2:
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5436
Mailing Address - Country:US
Mailing Address - Phone:203-376-9880
Mailing Address - Fax:860-878-6867
Practice Address - Street 1:19 HILLSIDE LANE
Practice Address - Street 2:
Practice Address - City:YALESVILLE
Practice Address - State:CT
Practice Address - Zip Code:06492-0649
Practice Address - Country:US
Practice Address - Phone:203-376-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical