Provider Demographics
NPI:1629276829
Name:BURLILE, CHARLES JONATHAN (MA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JONATHAN
Last Name:BURLILE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3613
Mailing Address - Country:US
Mailing Address - Phone:508-366-9999
Mailing Address - Fax:
Practice Address - Street 1:86 ADAMS ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3613
Practice Address - Country:US
Practice Address - Phone:508-366-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 1552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health