Healthcare Provider Details

I. General information

NPI: 1386345874
Provider Name (Legal Business Name): KARL CHIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KARHOE CHIU

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EDGEWATER PLACE, SUITE 100, WAKEFIELD, MA 01880-128 SUITE 100
WAKEFIELD MA
01880-1281
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 857-230-9986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2838548
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15684
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB695608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: