Provider Demographics
NPI:1194886838
Name:CHARLES WOLFSON DBA ACTIVE COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:CHARLES WOLFSON DBA ACTIVE COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-366-5909
Mailing Address - Street 1:43 HOPKINTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2103
Mailing Address - Country:US
Mailing Address - Phone:508-366-5909
Mailing Address - Fax:508-366-5909
Practice Address - Street 1:43 HOPKINTON RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2103
Practice Address - Country:US
Practice Address - Phone:508-366-5909
Practice Address - Fax:508-366-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2009101YM0800X
MA3234103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1010340OtherBEACON HEALTH STRATEGIES
MAW10267OtherBLUE CROSS BLUE SHIELD
173930OtherMAGELLAN HEALTH SERVICES