Provider Demographics
NPI:1982282943
Name:LAGO-FAIREY, KAREN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:LAGO-FAIREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LINDA ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1728
Mailing Address - Country:US
Mailing Address - Phone:631-766-9912
Mailing Address - Fax:
Practice Address - Street 1:15 LINDA ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1728
Practice Address - Country:US
Practice Address - Phone:631-766-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health