Provider Demographics
NPI:1629155536
Name:LANDRY, KAREN A (LADC1)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LADC1
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, LADC1
Mailing Address - Street 1:22 COPLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-3604
Mailing Address - Country:US
Mailing Address - Phone:508-735-5374
Mailing Address - Fax:
Practice Address - Street 1:6 MAPLE ST STE 102
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1647
Practice Address - Country:US
Practice Address - Phone:508-735-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17980101Y00000X, 101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1313OtherBCBS