Provider Demographics
NPI:1174757595
Name:FOXWORTH, KAREN LYSTRE (MED)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYSTRE
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MOHAWK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1263
Mailing Address - Country:US
Mailing Address - Phone:781-828-9236
Mailing Address - Fax:781-828-9234
Practice Address - Street 1:48 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1263
Practice Address - Country:US
Practice Address - Phone:781-828-9236
Practice Address - Fax:781-828-9234
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health