1215199328 NPI number — MS. KAREN MICHELE KULCHIN MSW LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215199328 NPI number — MS. KAREN MICHELE KULCHIN MSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KULCHIN
Provider First Name:
KAREN
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STAHLHOTH
Provider Other First Name:
KAREN
Provider Other Middle Name:
MICHELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215199328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 SAINT THOMAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91377-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-225-0210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4766 PARK GRANADA
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-225-0210
Provider Business Practice Location Address Fax Number:
818-597-9069
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS16505 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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