Provider Demographics
NPI:1790118891
Name:FALLON, KARLA (LMHC, PHD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK AVE RM 1600
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5538
Mailing Address - Country:US
Mailing Address - Phone:347-229-6356
Mailing Address - Fax:
Practice Address - Street 1:100 PARK AVE RM 1600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5538
Practice Address - Country:US
Practice Address - Phone:347-229-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00421201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1790118891OtherNPI NUMBER