Provider Demographics
NPI:1134243090
Name:DEFALCO, KAREN L (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:DEFALCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:TIEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:77 ELBERTA DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5706
Mailing Address - Country:US
Mailing Address - Phone:516-316-0486
Mailing Address - Fax:631-499-0495
Practice Address - Street 1:356 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4332
Practice Address - Country:US
Practice Address - Phone:516-316-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016591103T00000X
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool