Provider Demographics
NPI:1629510094
Name:ST CHARLES, JANELLE (MA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:ST CHARLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BRIMMER ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2913
Mailing Address - Country:US
Mailing Address - Phone:207-337-2925
Mailing Address - Fax:
Practice Address - Street 1:39 BRIMMER ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2913
Practice Address - Country:US
Practice Address - Phone:207-337-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health