Provider Demographics
NPI:1508017724
Name:TAYLOR, KAREN WAITE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:WAITE
Last Name:TAYLOR
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 1:5 BROOKDALE LN
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1400
Mailing Address - Country:US
Mailing Address - Phone:978-433-7746
Mailing Address - Fax:
Practice Address - Street 1:77 E. MERRIMACK STREET, UNIT #1
Practice Address - Street 2:SOUTH BAY MENTAL HEALTH
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-453-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical