Provider Demographics
NPI:1508133869
Name:KARONIS, THEODORE P (MASTER)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:P
Last Name:KARONIS
Suffix:
Gender:M
Credentials:MASTER
Other - Prefix:MR
Other - First Name:THEODORE
Other - Middle Name:P
Other - Last Name:KARONIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTER
Mailing Address - Street 1:206 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3149
Mailing Address - Country:US
Mailing Address - Phone:408-230-1118
Mailing Address - Fax:
Practice Address - Street 1:206 OCEAN ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3149
Practice Address - Country:US
Practice Address - Phone:408-230-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor