Provider Demographics
NPI:1992589931
Name:CHARLES, CLAUDETTE
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:HOME AIDE
Other - Last Name:AGENCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:151 COOLIDGE AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2866
Mailing Address - Country:US
Mailing Address - Phone:781-709-6886
Mailing Address - Fax:
Practice Address - Street 1:131 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2868
Practice Address - Country:US
Practice Address - Phone:781-709-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health