Provider Demographics
NPI:1124032842
Name:OLMSCHEID-KOERNER, KAREN ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:OLMSCHEID-KOERNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:OLMSCHEID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1337 CAMINO DEL MAR
Mailing Address - Street 2:SUITE E
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2504
Mailing Address - Country:US
Mailing Address - Phone:858-792-6829
Mailing Address - Fax:760-943-7666
Practice Address - Street 1:1337 CAMINO DEL MAR
Practice Address - Street 2:SUITE E
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2504
Practice Address - Country:US
Practice Address - Phone:858-792-6829
Practice Address - Fax:760-943-7666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY180530Medicaid
CAPSY180530Medicaid