Provider Demographics
NPI:1487043501
Name:KAREN PEABODY, LICSW
Entity Type:Organization
Organization Name:KAREN PEABODY, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEABODY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:774-222-3196
Mailing Address - Street 1:36 N BEDFORD ST
Mailing Address - Street 2:SC22
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1186
Mailing Address - Country:US
Mailing Address - Phone:774-222-3196
Mailing Address - Fax:774-221-9196
Practice Address - Street 1:36 N BEDFORD ST
Practice Address - Street 2:SC22
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1186
Practice Address - Country:US
Practice Address - Phone:774-222-3196
Practice Address - Fax:774-221-9196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty