Provider Demographics
NPI:1215554571
Name:CEDERBERG, CHARLES D (MA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:CEDERBERG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:151 MERRIMAC ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4714
Mailing Address - Country:US
Mailing Address - Phone:617-643-6010
Mailing Address - Fax:
Practice Address - Street 1:151 MERRIMAC ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4714
Practice Address - Country:US
Practice Address - Phone:617-643-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11948103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist