Provider Demographics
NPI:1962715482
Name:STANGE, KAREN DENISE (LCPC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DENISE
Last Name:STANGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1237
Mailing Address - Country:US
Mailing Address - Phone:207-942-5055
Mailing Address - Fax:207-942-7013
Practice Address - Street 1:265 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4610
Practice Address - Country:US
Practice Address - Phone:207-942-5055
Practice Address - Fax:207-942-7013
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC62898101Y00000X
FLMH7173101YM0800X
MECC3663101YP2500X
FLMT2435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist