Provider Demographics
NPI:1144255209
Name:KARAKU, ALEX THEODORE (PHD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:THEODORE
Last Name:KARAKU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 JAQUES AVE
Mailing Address - Street 2:OUTPATIENT SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2476
Mailing Address - Country:US
Mailing Address - Phone:508-860-1260
Mailing Address - Fax:508-860-1068
Practice Address - Street 1:72 JAQUES AVE
Practice Address - Street 2:OUTPATIENT SERVICES
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2476
Practice Address - Country:US
Practice Address - Phone:508-860-1260
Practice Address - Fax:508-860-1068
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7613103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51005Medicare ID - Type Unspecified