Healthcare Provider Details

I. General information

NPI: 1376710897
Provider Name (Legal Business Name): KARYN PLICKERT BRISTOL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HARVARD RD
STOW MA
01775-1027
US

IV. Provider business mailing address

66 HARVARD RD
STOW MA
01775-1027
US

V. Phone/Fax

Practice location:
  • Phone: 508-561-5536
  • Fax:
Mailing address:
  • Phone: 508-561-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: