Provider Demographics
NPI:1528353455
Name:WACHS, KAREN THERESE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:THERESE
Last Name:WACHS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 376, 405 CONCORD AVE.
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-7800
Mailing Address - Country:US
Mailing Address - Phone:617-855-8067
Mailing Address - Fax:
Practice Address - Street 1:405 CONCORD AVE UNIT 376
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-7818
Practice Address - Country:US
Practice Address - Phone:617-855-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist