Healthcare Provider Details

I. General information

NPI: 1689094245
Provider Name (Legal Business Name): KAREN DATRES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ATWOOD DR SUITE 301
NORTHAMPTON MA
01060-4272
US

IV. Provider business mailing address

22 MONROE AVE
SHELBURNE FALLS MA
01370-1405
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-1314
  • Fax:
Mailing address:
  • Phone: 413-625-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: