Provider Demographics
NPI:1043794365
Name:FRASER, KERRIANNE ROSE KARLBERG
Entity Type:Individual
Prefix:
First Name:KERRIANNE
Middle Name:ROSE KARLBERG
Last Name:FRASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 PLEASANT ST UNIT 50
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-2554
Mailing Address - Country:US
Mailing Address - Phone:781-724-5393
Mailing Address - Fax:
Practice Address - Street 1:770 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-4006
Practice Address - Country:US
Practice Address - Phone:781-335-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1213991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical