Provider Demographics
NPI:1235229436
Name:BUETENS, KAREN (LICSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BUETENS
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:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-0004
Mailing Address - Country:US
Mailing Address - Phone:781-395-1560
Mailing Address - Fax:781-391-5564
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3848
Practice Address - Country:US
Practice Address - Phone:781-395-1560
Practice Address - Fax:781-391-5564
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1828101YA0400X
MA10211171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853066Medicaid
MA1853066Medicaid
MAPO6501Medicare ID - Type Unspecified