Provider Demographics
NPI:1841215142
Name:BALDERRAMA, KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BALDERRAMA
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 1:5050 N 8TH PL
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3202
Mailing Address - Country:US
Mailing Address - Phone:602-285-9696
Mailing Address - Fax:602-277-5930
Practice Address - Street 1:5050 N 8TH PL
Practice Address - Street 2:SUITE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3202
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:602-277-5930
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-1610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health