Provider Demographics
NPI:1447629977
Name:PEKOR, CARRIE (LICSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:PEKOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:PEKOR
Other - Last Name:JASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:19 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460
Mailing Address - Country:US
Mailing Address - Phone:617-943-4021
Mailing Address - Fax:
Practice Address - Street 1:173 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4005
Practice Address - Country:US
Practice Address - Phone:617-244-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1184971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical