Provider Demographics
NPI:1144341173
Name:DELFINO, KAREN (RPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DELFINO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:111 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2197
Mailing Address - Country:US
Mailing Address - Phone:203-735-8336
Mailing Address - Fax:203-735-3704
Practice Address - Street 1:111 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2197
Practice Address - Country:US
Practice Address - Phone:203-735-8336
Practice Address - Fax:203-735-3704
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080002440CT01OtherBLUE CROSS
CTANC1153OtherOXFORD
CTOV1301OtherHEALTHNET
CT076562Medicare ID - Type Unspecified