Provider Demographics
NPI:1063737468
Name:CHARLES, ROBERT M (MDIV)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 SILVER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5239
Mailing Address - Country:US
Mailing Address - Phone:617-594-0641
Mailing Address - Fax:617-696-8849
Practice Address - Street 1:1534 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2929
Practice Address - Country:US
Practice Address - Phone:617-306-6812
Practice Address - Fax:617-718-2724
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist