Basic Information
| Provider Information | |||||||||
| NPI: | 1710324470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | JO MORSE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORSE | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | JO | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW, LICSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502319 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 PLYMOUTH ST | ||||||||
| Address2: | |||||||||
| City: | HALIFAX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023381342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814222950 | ||||||||
| FaxNumber: | 7814222955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 107044 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.