Provider Demographics
NPI:1720159932
Name:CLOW-MILROY, KAREN ANN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:CLOW-MILROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BOG RIVER BND
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3328
Mailing Address - Country:US
Mailing Address - Phone:508-539-0603
Mailing Address - Fax:508-477-9334
Practice Address - Street 1:400 NATHAN ELLIS HWY
Practice Address - Street 2:#1
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3143
Practice Address - Country:US
Practice Address - Phone:508-477-5488
Practice Address - Fax:508-477-9334
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1275OtherBCBS MA