Provider Demographics
NPI:1407980451
Name:KARP, ELEANOR BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:BETH
Last Name:KARP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 WELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1033
Mailing Address - Country:US
Mailing Address - Phone:617-325-6099
Mailing Address - Fax:
Practice Address - Street 1:372 WELD ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1033
Practice Address - Country:US
Practice Address - Phone:617-325-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3347103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03451OtherBLUE CROSS-BLUE SHIELD
MA0513083Medicaid
MAW03451OtherBLUE CROSS-BLUE SHIELD