Provider Demographics
NPI:1285967331
Name:FENSTERMAKER, CHARLETTE L (MED LADC1)
Entity type:Individual
Prefix:MS
First Name:CHARLETTE
Middle Name:L
Last Name:FENSTERMAKER
Suffix:
Gender:F
Credentials:MED LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-2419
Mailing Address - Country:US
Mailing Address - Phone:508-369-1712
Mailing Address - Fax:
Practice Address - Street 1:67 FOLSOM AVE
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1137
Practice Address - Country:US
Practice Address - Phone:508-378-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA15060101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health