Provider Demographics
NPI:1265818751
Name:GRAVEL, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GRAVEL
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 1:106 SPRING ST STE 312
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5952
Mailing Address - Country:US
Mailing Address - Phone:508-202-0741
Mailing Address - Fax:
Practice Address - Street 1:106 SPRING ST STE 312
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5952
Practice Address - Country:US
Practice Address - Phone:508-202-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10861101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health