Provider Demographics
NPI:1821761719
Name:PADILLA, KAREN VANESSA (LMSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:VANESSA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3799
Mailing Address - Country:US
Mailing Address - Phone:319-687-6800
Mailing Address - Fax:
Practice Address - Street 1:109 OREGON AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3799
Practice Address - Country:US
Practice Address - Phone:631-687-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker