Provider Demographics
NPI:1740728534
Name:KOCIS, KAREN SUE (MA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:KOCIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2359 KNOLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1525
Mailing Address - Country:US
Mailing Address - Phone:216-260-1405
Mailing Address - Fax:
Practice Address - Street 1:333 N MIDDLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1001
Practice Address - Country:US
Practice Address - Phone:330-728-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
PABH000860103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst