Provider Demographics
NPI:1043002678
Name:DE HARO, KAREN DINORAH
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DINORAH
Last Name:DE HARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STAGE COACH LN
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5663
Mailing Address - Country:US
Mailing Address - Phone:424-210-1620
Mailing Address - Fax:
Practice Address - Street 1:11287 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4615
Practice Address - Country:US
Practice Address - Phone:424-210-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-19-77007106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician