Provider Demographics
NPI:1922215862
Name:SEABLOM, KAREN J (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
Last Name:SEABLOM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SCHOOLEYS MOUNTAIN RD
Mailing Address - Street 2:BLG 1A
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4001
Mailing Address - Country:US
Mailing Address - Phone:908-852-7664
Mailing Address - Fax:908-852-7655
Practice Address - Street 1:488 SCHOOLEYS MOUNTAIN RD
Practice Address - Street 2:BLG 1A
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4001
Practice Address - Country:US
Practice Address - Phone:908-852-7664
Practice Address - Fax:908-852-7655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01366200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135202Medicaid
NJ185366OtherMHN PRACTITIONER ID #
NJ7552191Medicare UPIN
NJ185366OtherMHN PRACTITIONER ID #
NJQ31843Medicare ID - Type Unspecified