Provider Demographics
NPI:1619288362
Name:CARAKER, KAREN MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:CARAKER
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 1:26 POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2720
Mailing Address - Country:US
Mailing Address - Phone:413-682-4218
Mailing Address - Fax:
Practice Address - Street 1:6 HATFIELD ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-7425
Practice Address - Fax:413-584-7440
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151211041C0700X, 1041C0700X
MA11511211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019920Medicaid
VT1019920Medicaid