1427264100 NPI number — MS. KAREN PERRY WILSON LMHC MED CAGS

Table of content: MS. KAREN PERRY WILSON LMHC MED CAGS (NPI 1427264100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427264100 NPI number — MS. KAREN PERRY WILSON LMHC MED CAGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
KAREN
Provider Middle Name:
PERRY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC MED CAGS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON-PLAZA
Provider Other First Name:
KAREN
Provider Other Middle Name:
PERRY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427264100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 JESSIE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01027-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-527-3832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WASHINGTON ST STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-4768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-843-3683
Provider Business Practice Location Address Fax Number:
781-848-0206
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LMHC4821 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4821 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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