Healthcare Provider Details

I. General information

NPI: 1992810584
Provider Name (Legal Business Name): KAREN F MEEKS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 STONEY HILL LANE
WEST TISBURY MA
02575
US

IV. Provider business mailing address

59 STONEY HILL LANE PO BOX 129
WEST TISBURY MA
02575
US

V. Phone/Fax

Practice location:
  • Phone: 508-728-7021
  • Fax: 508-696-5949
Mailing address:
  • Phone: 508-696-0863
  • Fax: 508-696-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11301
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004568
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: