Provider Demographics
NPI:1942657317
Name:WAKELEY, KAREN LYNN (MPS, LPC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:WAKELEY
Suffix:
Gender:F
Credentials:MPS, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1379
Mailing Address - Country:US
Mailing Address - Phone:203-834-5020
Mailing Address - Fax:203-563-9936
Practice Address - Street 1:1445 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1379
Practice Address - Country:US
Practice Address - Phone:203-834-5020
Practice Address - Fax:203-563-9936
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional