Provider Demographics
NPI:1003038662
Name:KARLSON, RUTH L (LICSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:KARLSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095
Mailing Address - Country:US
Mailing Address - Phone:413-599-1860
Mailing Address - Fax:
Practice Address - Street 1:303 BEECH ST
Practice Address - Street 2:RIVER VALLEY COUNSELING CENTER
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-540-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10175511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO6330OtherBLUE CROSS BLUE SHIELD
MAPO6330Medicare ID - Type Unspecified