Provider Demographics
NPI:1568648483
Name:GEMBOSKI, KAREN ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANN
Last Name:GEMBOSKI
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 1:146 B ASH LAND AVEENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550
Mailing Address - Country:US
Mailing Address - Phone:774-310-1806
Mailing Address - Fax:774-310-1807
Practice Address - Street 1:78 MOLASSES HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01506-1702
Practice Address - Country:US
Practice Address - Phone:774-499-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1142671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001119201Medicare PIN