Provider Demographics
NPI:1700830346
Name:DAGUE, KAREN M (LCSW-R)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:DAGUE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:YACANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 COURT STREET
Mailing Address - Street 2:STE 42
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT STREET
Practice Address - Street 2:STE 42
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0498291041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01682659Medicaid
NY7480227OtherGHI VALUE OPTIONS
NY01682659Medicaid