Provider Demographics
NPI:1285355628
Name:REIDY, KARINA DEANDRADE
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:DEANDRADE
Last Name:REIDY
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 1:400 FOXBORO BLVD APT 4201
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-3807
Mailing Address - Country:US
Mailing Address - Phone:617-388-3291
Mailing Address - Fax:
Practice Address - Street 1:20 CABOT BLVD STE 227
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1183
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty