Basic Information
| Provider Information | |||||||||
| NPI: | 1093702581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASBROUCK | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 BREMO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042881881 | ||||||||
| FaxNumber: | 8042826413 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 BREMO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042881881 | ||||||||
| FaxNumber: | 8042826413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 12/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904004934 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 009999841 | 05 | VA | MEDICAID | 7530514 | 01 | AETNA | OTHER | 228773 | 01 | COMPSYCH | OTHER | 55729000 | 01 | MAGELLAN | OTHER | 301263 | 01 | ANTHEM HEALTHKEEPERS | OTHER | 861112647 | 01 | UBH | OTHER | 0803313M | 01 | OPTIMA | OTHER | 289387 | 01 | ANTHEM | OTHER | 2222943 | 01 | CIGNA | OTHER |