Provider Demographics
NPI:1275511958
Name:COCCOLUTO, KAREN ANNE (APRN BC PC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANNE
Last Name:COCCOLUTO
Suffix:
Gender:F
Credentials:APRN BC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 MAIN POLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-9602
Mailing Address - Country:US
Mailing Address - Phone:413-369-4746
Mailing Address - Fax:
Practice Address - Street 1:206 STATE ST
Practice Address - Street 2:#206
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2265
Practice Address - Country:US
Practice Address - Phone:413-320-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108491364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2143127OtherCIGNA
MAPN0818OtherBCBS
MA131404000OtherMAGELLAN
MA1893289Medicaid
MA467761OtherTUFTS
MA131404000OtherMAGELLAN
MA1893289Medicaid