Healthcare Provider Details

I. General information

NPI: 1366089831
Provider Name (Legal Business Name): KARA ELIZABETH KATZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KARA ELIZABETH KELLEY

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 HANCOCK ST STE 205
QUINCY MA
02169-4371
US

IV. Provider business mailing address

1212 HANCOCK ST STE 205
QUINCY MA
02169-4371
US

V. Phone/Fax

Practice location:
  • Phone: 617-249-4419
  • Fax:
Mailing address:
  • Phone: 617-249-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127587
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: