Provider Demographics
NPI:1538752712
Name:COUSIN, KAREN G (LMSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:G
Last Name:COUSIN
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 1:34 S BROADWAY STE 208
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4431
Mailing Address - Country:US
Mailing Address - Phone:914-582-7185
Mailing Address - Fax:
Practice Address - Street 1:34 S BROADWAY STE 208
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4431
Practice Address - Country:US
Practice Address - Phone:914-582-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110507-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker