Provider Demographics
NPI:1972679108
Name:CONNERY, KAREN SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SUE
Last Name:CONNERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-0908
Mailing Address - Country:US
Mailing Address - Phone:941-365-1661
Mailing Address - Fax:
Practice Address - Street 1:405 JULIA PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6915
Practice Address - Country:US
Practice Address - Phone:941-365-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004108103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73406Medicare ID - Type Unspecified