Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1017551 | MA |
NPI | 1003038662 |
---|---|
Provider Name | Ruth L Karlson |
First Address | Wilbraham, MA 01095 |
Second Address | Holyoke, MA 01040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PO6330 | BLUE CROSS BLUE SHIELD (01) | MA |