Provider Demographics
NPI:1891857900
Name:MANUKAS-GRIFFIN, KAREN MADDOX (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MADDOX
Last Name:MANUKAS-GRIFFIN
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 1:39 BRAESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1644
Mailing Address - Country:US
Mailing Address - Phone:203-281-4299
Mailing Address - Fax:
Practice Address - Street 1:3208 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2158
Practice Address - Country:US
Practice Address - Phone:203-281-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0031071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT079441OtherMHN
CT800002498Medicare ID - Type Unspecified