Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY5055 | GU |
Y | 103G00000X | Clinical Psychologist | PY5055 | FL |
Y | 103TC0700X | Clinical Psychologist | PY5055 | FL |
N | 103TH0100X | Health Service | PY5055 | FL |
NPI | 1275669921 |
---|---|
Provider Name | Dr. Karen Marie Milo |
First Address | Bradenton, FL 34211-7174 |
Second Address | Bradenton, FL 34211-7174 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59577 | BCBS (01) | FL |