Healthcare Provider Details

I. General information

NPI: 1588170906
Provider Name (Legal Business Name): TATIANA KING MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W MAIN ST
DUDLEY MA
01571-3817
US

IV. Provider business mailing address

9 VICTORIA AVE
WORCESTER MA
01607-1896
US

V. Phone/Fax

Practice location:
  • Phone: 774-757-2254
  • Fax:
Mailing address:
  • Phone: 508-320-2688
  • Fax: 508-320-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126041
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: