Provider Demographics
NPI:1912432303
Name:GERSHANOV, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GERSHANOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3375
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:303-726-6841
Mailing Address - Fax:877-345-3501
Practice Address - Street 1:1840 WOODMOOR DR STE 100
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9083
Practice Address - Country:US
Practice Address - Phone:303-726-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0004532103TC0700X
CO0004532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical