Provider Demographics
NPI:1427264100
Name:WILSON, KAREN PERRY (LMHC MED CAGS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:PERRY
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC MED CAGS
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:PERRY
Other - Last Name:WILSON-PLAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:9 JESSIE LANE
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2121
Mailing Address - Country:US
Mailing Address - Phone:413-527-3832
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4768
Practice Address - Country:US
Practice Address - Phone:781-843-3683
Practice Address - Fax:781-848-0206
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC4821101Y00000X
MA4821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor