Provider Demographics
NPI:1295959930
Name:WILSON, KAREN KAHN (EDD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:KAHN
Last Name:WILSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:B
Other - Last Name:KAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:15 DANBURY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6820
Mailing Address - Country:US
Mailing Address - Phone:203-227-7274
Mailing Address - Fax:
Practice Address - Street 1:15 DANBURY AVE
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-6820
Practice Address - Country:US
Practice Address - Phone:203-227-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2546103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist