Basic Information
| Provider Information | |||||||||
| NPI: | 1316444573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CESPEDES | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 EDGEWORTH ST # 1 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016053223 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021844729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7218433783 | ||||||||
| FaxNumber: | 7818480206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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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 | 101Y00000X | MA | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 8177926298701 | 01 | MA | MASS HEALTH | OTHER |