Basic Information
| Provider Information | |||||||||
| NPI: | 1801495833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAIRCHILD | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | MARIE CODD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MPS, LCAT, ATR-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CODD | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | MPS, LCAT, ATR-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 364 S 1ST ST APT 20 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112114725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172569665 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8900 VAN WYCK EXPY | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182067160 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 001953 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.