Provider Demographics
NPI:1366577603
Name:PATRICK, KAREN ELLEN (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELLEN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 CAITO DR BLDG 6 STE 110
Mailing Address - Street 2:
Mailing Address - City:INDPLS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1375
Mailing Address - Country:US
Mailing Address - Phone:317-335-4227
Mailing Address - Fax:317-341-1112
Practice Address - Street 1:5674 CAITO DR BLDG 6 STE 110
Practice Address - Street 2:
Practice Address - City:INDPLS
Practice Address - State:IN
Practice Address - Zip Code:46226-1369
Practice Address - Country:US
Practice Address - Phone:317-335-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004160A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker