Provider Demographics
NPI:1487936498
Name:BAILEY ADDISON, KAREN L (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:BAILEY ADDISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 COVENTRY ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1519
Mailing Address - Country:US
Mailing Address - Phone:860-371-4549
Mailing Address - Fax:860-493-0756
Practice Address - Street 1:1229 ALBANY AVE STE 4
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2156
Practice Address - Country:US
Practice Address - Phone:860-293-1000
Practice Address - Fax:860-293-1031
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0016661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical