Provider Demographics
NPI:1699899591
Name:PUOPOLO, KAREN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PUOPOLO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1017
Mailing Address - Country:US
Mailing Address - Phone:508-839-2249
Mailing Address - Fax:
Practice Address - Street 1:176 WORCESTER PROVIDENCE TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:SUTTON
Practice Address - State:MA
Practice Address - Zip Code:01590-1901
Practice Address - Country:US
Practice Address - Phone:508-581-8797
Practice Address - Fax:508-581-8796
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08720OtherBLUE CROSS BLUE SHIELD
MA9444147OtherPRIVATE HEALTH CARE SYSTE