Provider Demographics
NPI:1154044576
Name:LILLEY HAUGHEY, KAREN KELLEY
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:KELLEY
Last Name:LILLEY HAUGHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:K
Other - Last Name:LILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5807 ROLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1309
Mailing Address - Country:US
Mailing Address - Phone:443-900-2839
Mailing Address - Fax:
Practice Address - Street 1:5807 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1309
Practice Address - Country:US
Practice Address - Phone:443-900-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD095751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical