Provider Demographics
NPI:1639201544
Name:MARVISTA PSYCHOLOGICAL ASSOCIATE, P.C.
Entity Type:Organization
Organization Name:MARVISTA PSYCHOLOGICAL ASSOCIATE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MUNDHENK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-383-0860
Mailing Address - Street 1:12 PARKINGWAY
Mailing Address - Street 2:P.O.BOX 146
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1708
Mailing Address - Country:US
Mailing Address - Phone:781-383-0860
Mailing Address - Fax:781-383-1239
Practice Address - Street 1:12 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1708
Practice Address - Country:US
Practice Address - Phone:781-383-0860
Practice Address - Fax:781-383-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X, 103TC0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty