Provider Demographics
NPI:1780624650
Name:HARTEN BROIDA, KAREN (MFT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HARTEN BROIDA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GRODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 970
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1234
Practice Address - Country:US
Practice Address - Phone:858-558-2731
Practice Address - Fax:858-452-5905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist