Provider Demographics
NPI:1033206354
Name:MUNDHENK, CHARLES F (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:MUNDHENK
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 1:223 CHIEF JUSTICE CUSHING HWY STE 204
Mailing Address - Street 2:P.O. BOX 146
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1391
Mailing Address - Country:US
Mailing Address - Phone:781-383-0860
Mailing Address - Fax:781-383-1239
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY STE 204
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-0860
Practice Address - Fax:781-383-1239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical