Provider Demographics
NPI:1588159818
Name:LIAZOS, KAREN SOPHIA
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SOPHIA
Last Name:LIAZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:SOPHIA
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:72 BOW ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3041
Mailing Address - Country:US
Mailing Address - Phone:781-861-7688
Mailing Address - Fax:
Practice Address - Street 1:72 BOW ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3041
Practice Address - Country:US
Practice Address - Phone:781-861-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1038931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical