MEDICARE: MS. SHARA THERESA KATSOS 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	111476	MA

General Provider Information

NPI Number	:	1720031164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARA THERESA KATSOS LICSW

Provider Business Mailing Address
First Line	:	200 SPRINGS RD
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1198
Country	:	US
Telephone Number	:	508-801-8294
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SPRINGS RD
Second Line	:
City	:	BEDFORD
State	:	MA
Zip	:	01730-1198
Country	:	US
Telephone Number	:	508-801-8294
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/28/2022

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