Provider Demographics
NPI:1104982529
Name:ROOS, KAREN RICHARDSON
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RICHARDSON
Last Name:ROOS
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 1:53 GREENOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6152
Mailing Address - Country:US
Mailing Address - Phone:617-306-2280
Mailing Address - Fax:
Practice Address - Street 1:877 BEACON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3801
Practice Address - Country:US
Practice Address - Phone:617-266-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical