MEDICARE: KAREN PUOPOLO MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	110476	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P08720	OTHER	MA	BLUE CROSS BLUE SHIELD
2	9444147	OTHER	MA	PRIVATE HEALTH CARE SYSTE

General Provider Information

NPI Number	:	1699899591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN PUOPOLO MSW, LICSW

Provider Business Mailing Address
First Line	:	157 MILLBURY ST
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1017
Country	:	US
Telephone Number	:	508-839-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 WORCESTER PROVIDENCE TPKE
Second Line	:	SUITE 203
City	:	SUTTON
State	:	MA
Zip	:	01590-1901
Country	:	US
Telephone Number	:	508-581-8797
Fax Number	:	508-581-8796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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