Basic Information
| Provider Information | |||||||||
| NPI: | 1720685472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRUCCI | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 WASHINGTON ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173252993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 WASHINGTON ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173255618 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2020 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | MA | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.