Healthcare Provider Details

I. General information

NPI: 1063191617
Provider Name (Legal Business Name): KARI TERESA LUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST
DANVERS MA
01923-2121
US

IV. Provider business mailing address

244 CARLISLE RD
BEDFORD MA
01730-1535
US

V. Phone/Fax

Practice location:
  • Phone: 978-767-2847
  • Fax:
Mailing address:
  • Phone: 339-223-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: