Provider Demographics
NPI:1255346839
Name:FATTOROSI, KAREN B (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:B
Last Name:FATTOROSI
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 SE 24TH RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6010
Mailing Address - Country:US
Mailing Address - Phone:352-854-5946
Mailing Address - Fax:352-854-5946
Practice Address - Street 1:1294 SE 24TH RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6010
Practice Address - Country:US
Practice Address - Phone:352-854-5946
Practice Address - Fax:352-854-5946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 78711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035214Medicare ID - Type Unspecified
FLZ083FMedicare ID - Type UnspecifiedBC/BS MEDICARE PROVIDER N