Provider Demographics
NPI:1063703460
Name:EARLE, KAREN MARIE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:EARLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LICSW
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-0048
Mailing Address - Country:US
Mailing Address - Phone:610-444-5976
Mailing Address - Fax:
Practice Address - Street 1:10 SEARS ST
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1009
Practice Address - Country:US
Practice Address - Phone:610-444-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1182111041C0700X
PACW0160471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical