Provider Demographics
NPI:1528107810
Name:LEE, KAREN BARNICO (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BARNICO
Last Name:LEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2240
Mailing Address - Country:US
Mailing Address - Phone:978-475-6950
Mailing Address - Fax:
Practice Address - Street 1:2 DUNDEE PARK DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3735
Practice Address - Country:US
Practice Address - Phone:978-475-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABAPO4439OtherLICSW BLUE CROSS BLUE SHI
MABAPO4439OtherLICSW BLUE CROSS BLUE SHI